Incidence Rate of Post-Kidney Transplant Infection Discussion Paper

End-stage renal disease is best treated by a kidney transplant, which prolongs life and improves the quality of life. Overbeck et al.¹ suggest that long-term immunosuppression is required to avoid organ rejection, but this comes at the cost of a greater risk of infection and malignancy. Besides, other studies reveal that infection is the second most significant cause of mortality in kidney transplant patients and has been linked to a lower survival rate for the transplanted organ. In this article, “Incidence Rate of Post-Kidney Transplant Infection: A Retrospective Cohort Study Examining Infection Rates at a Large Canadian Multicenter Tertiary-Care Facility,” Cowan et al.² investigated the incidence and kinds of post-operative infections in kidney transplant patients. Though this article concluded that infections, especially urinary tract infections, were frequent and caused considerable morbidity, there were notable shortcomings related to the follow-up duration and generalization of results.

Cowan et al.² conducted a retrospective cohort study in a large multicenter tertiary-care facility and observed patients. The study took place at The Ottawa Hospital and lasted for two years. The patients in this study were 142 adults who transplanted kidneys in 2011 and 2012. Transplantation of several organs was excluded. At the beginning of this study, all demographic, clinical data, and transplant protocols were collected using Microsoft Excel for categorical and continuous variables, and PASS 2008, NCC, LLC, Kaysville, and Utah for analysis. In this investigation, infection was identified as clinical infectious signs and symptoms verified positive by microbiological tests, except Urinary Tract Infections (UTIs), which were defined as significant bacteriuria. As a result, the study showed that 44 patients had infections with the rate of 36.2 per 100 patients during the two years. The infections were associated with hospitalization, urinary tract infections, cytomegalovirus and bacteremia. Three death cases occurred due to urosepsis, intracerebral hemorrhage, and congestive heart failure. Incidence Rate of Post-Kidney Transplant Infection Discussion Paper

Despite the significant findings, this study faced several limitations. First and foremost, the follow-up duration was relatively short. Although this study had the most extended follow-up period compared to similar studies, the follow-up was relatively short. For instance, Cowan et al.². performed a follow-up of only two years to examine the post-kidney incidence rates. According to Von et al.³, follow-ups in medical research helps to assess the effects of variables over time to ascertain their efficacy and investigate the possibility of side effects after the experiment. Therefore, the short follow-up period limited the reliability of findings since the patients could develop adverse transplant complications even after two years. Secondly, the outcomes could not be generalized to the entire population of patients who undergo kidney transplants. For instance, identifying the infection rate by the positive microbiology data was prone to underestimating infection rates, leading to inaccurate findings and limiting generalization. Besides, the researchers only considered patients diagnosed and hospitalized in their clinical center during the study. As such, excluding members in other hospitals undermined the accuracy of findings and contributed to biased generalization.

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According to Polit and Beck⁴, research outcomes should cover a large sample and employ proper data collection mechanisms for adequate generalization. On the other hand, some scholars may have different claims concerning the follow-up and generalization. For instance, Shen et al.⁵ argue that surveys concentrated on one study center are likely to be precise and accurate due to close monitoring and comprehensive assessments. Besides, Cowan et al. claim that their study had the most extended follow-up period; thus, the outcomes are accurate and reliable. Incidence Rate of Post-Kidney Transplant Infection Discussion Paper Nevertheless, Polit and Beck argue that medical studies should have a wider distribution of participants based on their demographic variables to enhance generalization. Additionally, they suggest that an extended follow-up of at least three years should be employed to assess the long-term effects of variables better.⁴

In conclusion, the authors established that infections, particularly urinary tract infections, were common and caused significant morbidity and hospitalization. However, this study’s findings were limited by short follow-up and non-generalization. The two-year period was short of examining the long-term effects of post-kidney infections. Besides, the positive microbiology data undermined the thorough investigation of the urinary tract infection rates. Further, intervention studies are required to assess treatments targeted at further decreasing infection rates, currently under development. In addition, further intervention studies are essential for finding more effective strategies to minimize post-kidney transplant infection rates.

Reference

1. Overbeck, I., Bartels, M., Decker, O., Harms, J., Hauss, J., & Fangmann, J. (2005, April). Changes in quality of life after renal transplantation. In Transplantation proceedings (Vol. 37, No. 3, pp. 1618-1621). Elsevier. Available from: https://www.sciencedirect.com/science/article/abs/pii/S0041134504010899
2. Cowan J, Bennett A, Fergusson N, McLean C, Mallick R, Cameron DW, Knoll G. Incidence rate of post-kidney transplant infection: a retrospective cohort study examining infection rates at a large Canadian multicenter tertiary-care facility. Canadian journal of kidney health and disease. 2018 Sep;5:2054358118799692. Available from: https://journals.sagepub.com/doi/pdf/10.1177/2054358118799692
3. von Allmen RS, Weiss S, Tevaearai HT, Kuemmerli C, Tinner C, Carrel TP, Schmidli J, Dick F. Completeness of follow-up determines validity of study findings: results of a prospective repeated measures cohort study. PloS one. 2015 Oct 15;10(10):e0140817. Available from: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0140817
4. Polit DF, Beck CT. Generalization in quantitative and qualitative research: Myths and strategies. International journal of nursing studies. 2010 Nov 1;47(11):1451-8. Available from: https://edulll.ekt.gr/edulll/bitstream/10795/2220/2/2220_1%20%20QUANTITY%20QUALITY.pdf
5. Shen TC, Wang IK, Wei CC, Lin CL, Tsai CT, Hsia TC, Sung FC, Kao CH. The risk of septicemia in end-stage renal disease with and without renal transplantation: a propensity-matched cohort study. Medicine. 2015 Aug;94(34).available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4602898/

Incidence Rate of Post-Kidney Transplant Infection Discussion Paper