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/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 nephropathyrelated 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.