Post-transplant infections now exceed acute rejection as cause for hospitalization: a report of the NAPRTCS.

Newer immunosuppressive agents have dramatically reduced the rates of acute graft rejection (AR) over the last decade but may have exacerbated the problem of post-transplant infections (PTI). We analyzed data from the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS) to determine the risks of hospitalization from PTI vs. AR in the years 1987-2000. For patients transplanted in 1987, the AR-associated hospitalization rate exceeded the equivalent hospitalization rate for PTI at both early (1-6 months) and later time points (6-24 months). In contrast, for patients transplanted in the year 2000, the PTI-associated hospitalization rate was twice that for AR-associated hospitalization during each time period. During the first two years post-transplant, rates of AR hospitalization trended significantly downwards (p < 0.001) while rates of PTI-associated hospitalization stayed constant. In the 6-24-month time period post-transplant, the risk of bacterial and viral infection-related hospitalization rose significantly from 1987 to 2000 (p < 0.001 for trend by transplant year). We conclude that the causes of hospitalization at all times up to 24 months post-transplant, including the critical early 6 months, have shifted away from AR to PTI.