Burn Patients with History of Kidney Transplant Experience Increased Incidence of Wound Infection

Ahmed Elfadaly; Helen Zhang; Jorge Ortiz M.D.; Weikai Qu; Michael Cooper; Munier M Nazzal

Objective: To determine if history of previous kidney transplant is an independent risk factor for increased incidence of wound infection and other morbidities in burn patients.

While the goal of immunosuppression post-organ transplantation is to prevent graft rejection, it is often associated with significant adverse effects such as increased susceptibility to infection, drug toxicity, and malignancy. Burn injuries lead to a dysregulated hypermetabolic state and a compromised cutaneous barrier which predisposes the body to infection and delayed wound healing. 

We surmise that a history of kidney transplant increases the risk of wound infection in in-hospital burn victims.

A retrospective analysis was performed on 57,948 adults diagnosed in-hospital with a burn injury between 2008-2014, obtained from the Nationwide Inpatient Sample (NIS) by Healthcare Cost and Utilization Project (HCUP).

In total, 103 burn victims (0.2%) with a history of kidney transplant (HTx) were identified. Compared to burn patients without a history of transplant (No-HTx), they were older (54.3±13.8 vs 49.8± 18.7; p=0.001), more likely to have Medicare insurance (69.9% vs 31.1%; p<0.001), and less likely to have Medicaid insurance (5.8% vs 17.2%; p=0.002). There were no significant differences in hospital characteristics and severity of burn between the two groups. HTx had a higher in-hospital mortality index score compared to non-HTx with p<0.001. The incidence rates of complications such as wound infection (33.0 vs 16.3; p<0.001) and acute renal failure (18.4 vs 7.7; p<0.001) were significantly higher in the HTx group. After adjusting for confounding factors in multivariable analysis, the incidence rate of wound infection remained significantly higher than that of the no-HTx group.

History of kidney transplant is an independent risk factor for increased incidence of wound infection in burn patients.