Early Post-Transplant Bacterial Infections Predict Long-Term Mortality in Kidney Transplant Recipients: A 10-Year Retrospective Cohort Study.

BACKGROUND Kidney transplant recipients require lifelong immunosuppression, predisposing them to bacterial infections that can impair survival. This study evaluated the impact of early bacterial infections on long-term mortality and sought to identify clinical and procedural predictors of infection. MATERIAL AND METHODS This retrospective study included kidney transplant recipients (2014-2024) with ≥12 months of follow-up. Bacterial infections were classified as early (≤6 months) or late (>6 months). Clinical, laboratory, and microbiological data were analyzed. Cox regression analysis identified independent predictors of mortality, and logistic regression determined factors associated with early infections. RESULTS Early bacterial infections occurred in 35.4% of patients and were independently associated with a 3-fold increase in mortality risk (adjusted hazard ratio [aHR]=3.03, 95% CI: 1.42-6.44, P=0.004). Diabetic nephropathy-related end-stage kidney disease (aHR=4.14, P=0.003) and older recipient age (aHR=1.10 per year, P<0.001) were additional independent predictors. The final Cox model demonstrated good discriminative performance (C-index=0.821). Urinary tract infections were most common (67%), followed by bloodstream infections (25%) and pneumonia (10%). Escherichia coli, Klebsiella spp., and Enterococcus spp. predominated. Low albumin and hemoglobin levels and ureteral stent placement were associated with early infection. Infection episodes were treated using antibiogram-guided therapy, and no multidrug-resistant organisms were identified. CONCLUSIONS Early infections and diabetic nephropathy-related ESKD predict long-term mortality after kidney transplantation. Optimizing nutritional status to improve albumin and hemoglobin levels, ensuring careful use and timely removal of ureteral stents, and implementing strict antibiogram-guided antibiotic stewardship can help reduce early infection risk. Targeted early interventions and closer surveillance of high-risk patients may improve long-term outcomes.