Patients who have received solid organ (kidney, liver, heart, lung, pancreas, or intestine) transplants face a high risk of developing severe sepsis, or life-threatening organ dysfunction in response to infection. Mr. John P. Donnelly, doctoral student in the department of epidemiology and predoctoral fellow in the division of preventive medicine at the University of Alabama at Birmingham, recently led a retrospective study to investigate how solid organ transplants influence outcomes after experiencing sepsis. Using 2012–2014 data from the University HealthSystem Consortium—a group of academic medical center affiliates that partnered with VHA Inc. and Novation in 2015, and is now known as Vizient — Mr. Donnelly and colleagues assessed the link between solid organ transplants and death in patients with severe sepsis.
[Photo: Mr. John P. Donnelly]
Mr. Donnelly identified 903,816 severe sepsis hospitalizations, of which 4.4 percent had solid organ transplants. Unexpectedly, among severe sepsis hospitalizations, in-hospital mortality was lower among those with prior transplants (5.5 percent versus 9.4 percent, adjusted odds ratio 0.83, 95 percent confidence interval [CI] 0.79–0.87). Compared with non-transplant patients, recipients of kidney and liver transplants demonstrated lower sepsis mortality, while lung recipients demonstrated increased odds of mortality.
The researchers concluded that determining the particular approaches taken with transplant recipients may indicate the most advantageous practices for both transplant and non-transplant patients hospitalized for sepsis. “We do not know if the observed associations could be explained by underlying health of the patient, physiologic mechanisms related to immunosuppression, or the quality of treatment received. A better understanding of the observed mortality differences has the potential to inform best practices for sepsis care,” Mr. Donnelly reports.
Co-investigators in the study are Dr. Jayme E. Locke, assistant professor, and Dr. Paul A. MacLennan, associate professor, in the division of transplantation; Dr. Gerald McGwin, Jr., professor and vice chair in the department of epidemiology; Dr. Roslyn B. Mannon, professor in the division of nephrology; Dr. Monika M. Safford, professor in the division of preventive medicine; Mr. John W. Baddley, professor in the division of infectious diseases; Dr. Paul Muntner, professor and vice chair in the department of epidemiology; and Dr. Henry E. Wang, professor in the department of emergency medicine.
“Inpatient Mortality Among Solid Organ Transplant Recipients Hospitalized for Sepsis and Severe Sepsis” was published in May in the journal Clinical Infectious Diseases.