Hospitalizations for bacterial endocarditis after renal transplantation inthe United States

Purpose: The national rate of and risk factors for bacterial endocarditis i n renal transplant recipients has not been reported. Methods: Retrospective registry study of 33,479 renal transplant recipients in the United States Renal Data System (USRDS) between I July 1994 and 30 June 1997. Hospitalizations for a primary diagnosis of bacterial endocardit is (ICD-9 codes 421.x) within three years after renal transplant were asses sed. Results: Renal transplant recipients had an unadjusted incidence ratio for endocarditis of 7.84 (95% confidence interval 4.72-13.25) in 1996. In multi variate analysis, a history of hospitalization for valvular heart disease ( adjusted odds ratio (AOR), 25.81, 95% confidence interval 11.28-59.07), gra ft loss (AOR, 2.81, 95% CI 1.34-5.09), and increased duration of dialysis p rior to transplantation were independently associated with hospitalizations for bacterial endocarditis after transplantation. Hospitalization for endo carditis was associated with increased patient mortality in Cox Regression analysis, hazard ratio 4.79, 95% CI 2.97-6.76. Conclusions: The overall incidence of bacterial endocarditis was much great er in renal transplant recipients than in the general population, although it is still relatively infrequent. Independent risk factors for bacterial e ndocarditis in the renal transplant recipients were identified, the most si gnificant of which was valvular heart disease. Endocarditis substantially i mpacts renal transplant recipient survival.