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Potential role of post-transplant hypogammaglobulinemia in the risk of Clostridium difficile infection after kidney transplantation: a case–control study

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Abstract

Purpose

To identify reversible risk factors for Clostridium difficile infection (CDI) after kidney transplantation (KT) that could lead to a reduction in its incidence and associated complications.

Methods

We performed a single-center case–control study in which 41 patients undergoing KT between February 2009 and July 2013 who developed a first episode of post-transplant CDI were included as cases. Patients transplanted at the same calendar day (±2 weeks) as each case with no evidence of CDI and comparable risk exposure period were chosen as controls (2:1 ratio). Serum immunoglobulin and complement levels were systematically measured at baseline and months 1 and 6 after transplantation.

Results

Multivariate regression analysis identified age-adjusted Charlson comorbidity index (odds ratio [OR] per unitary increment 1.31; P value = 0.043), delayed graft function (OR 2.76; P value = 0.039), prior cytomegalovirus (CMV) disease (OR 6.85; P value = 0.011) and prior acute graft rejection (OR 5.92; P value = 0.008) as risk factors for post-transplant CDI. Cases with their first episode of CDI occurring beyond the first month were more likely to have IgG hypogammaglobulinemia (HGG) at month 1 (P value = 0.002), whereas cases with CDI beyond the sixth month were more likely to have HGG of any class at month 6 (P value = 0.003). Poor outcome (graft loss and/or all-cause mortality) was more common among cases (adjusted hazard ratio 5.69; P value = 0.001).

Conclusion

The occurrence of CDI exerts a detrimental effect on graft and patient outcome. Post-transplant HGG was a potentially modifiable risk factor for CDI in KT recipients.

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Acknowledgments

The present study was partially supported by the Spanish Ministry of Economy and Competitiveness (Fondo de Investigaciones Sanitarias [FIS] project PI 11/01538) and the Fundación Mutua Madrileña de Investigación Médica (FMM Grant 2010/0015). Julia Origüen holds a research-training contract “Rio Hortega” (CM13/00180) from the Spanish Ministry of Economy and Competitiveness (Instituto de Salud Carlos III).

Conflicts of interest

Julia Origüen has received an unrestricted research grant from Astellas Pharma España. All other authors: none to declare.

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Authors and Affiliations

  1. Unit of Infectious Diseases, Hospital Universitario “12 de Octubre” (Centro de Actividades Ambulatorias, 2ª planta, bloque D, Avda. de Córdoba, s/n, 28041), Instituto de Investigación Hospital “12 de Octubre” (i+12), School of Medicine, Universidad Complutense, Madrid, Spain

    Julia Origüen, Mario Fernández-Ruiz, Carlos Lumbreras, Francisco López-Medrano, Tamara Ruiz-Merlo, Rafael San Juan, Ana García-Reyne & José María Aguado

  2. Department of Microbiology, Hospital Universitario “12 de Octubre”, Instituto de Investigación Hospital “12 de Octubre” (i+12), School of Medicine, Universidad Complutense, Madrid, Spain

    María Ángeles Orellana

  3. Department of Nephrology, Hospital Universitario “12 de Octubre”, Instituto de Investigación Hospital “12 de Octubre” (i+12), School of Medicine, Universidad Complutense, Madrid, Spain

    Esther González, Natalia Polanco & Amado Andrés

  4. Department of Immunology, Hospital Universitario “12 de Octubre”, Instituto de Investigación Hospital “12 de Octubre” (i+12), School of Medicine, Universidad Complutense, Madrid, Spain

    Estela Paz-Artal

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  1. Julia Origüen
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Correspondence to Julia Origüen.

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Origüen, J., Fernández-Ruiz, M., Lumbreras, C. et al. Potential role of post-transplant hypogammaglobulinemia in the risk of Clostridium difficile infection after kidney transplantation: a case–control study. Infection 43, 413–422 (2015). https://doi.org/10.1007/s15010-015-0737-2

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  • DOI: https://doi.org/10.1007/s15010-015-0737-2

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