Risk factors for trauma death among transplant recipients
Scott Serpico1, Monique John2, Rosy Manikath James3, Naoru Koizumi3, Jorge Ortiz2.
1Philadelphia College of Osteopathic Medicine, Philadelphia, PA, United States; 2Albany Medical College, Albany, NY, United States; 3George Mason University, Arlington, PA, United States
Objective: To identify demographic and morphometric risk factors for trauma death among kidney, liver and pancreas recipients.
Introduction: Trauma is a leading cause of death in the United States. Individuals with chronic disease, notably cancer, are at increased risk for death due to unintentional injury. This may stem from the psychosocial stress, poor quality of life and physical disability that result from serious illness. Though solid organ transplant has the potential to extend and improve the lives of those with chronic disease, these individuals may remain in a state of suboptimal physical and mental health after surgery that predisposes them to death from trauma.
Methods: A retrospective analysis was performed using UNOS data from 100,705 adults with a history of kidney, liver or pancreas transplant between 2000-2021. Basic patient, donor and transplant characteristics of the two groups (trauma death or all other cause death) were compared via univariate and multivariate statistical analysis. The trauma death group consisted of deceased recipients in the SRTR registry with the diagnosis code TRAUMA: MOTOR VEHICLE ACCIDENT or TRAUMA: OTHER. The risk factors compared include age, sex, ethnicity, wait time, BMI at the time of transplant, history of diabetes, glucocorticoid use, graft failure, as well as donor and transplant characteristics such as organ share type, donor age, sex and ethnicity. Statistical significance was defined by p-value <0.05.
Results: The data included 100,705 transplant recipients in total. The largest proportion of death secondary to trauma was seen in the kidney group (0.8%), followed by liver (0.7%) and then pancreas (0.3%). Male sex was the most significant risk factor for trauma death among kidney and liver recipients (OR=1.67, OR=1.68, respectively). Whites were also at elevated risk for trauma death relative to their non-White counterparts in the kidney and liver groups (OR=1.32, OR=1.31, respectively). In both of organ categories, age conferred a protective effect (OR=0.97 for kidney, OR=0.98 for liver). Unique findings in the kidney cohort include that those with a longer wait time were 0.02% less likely to die from trauma and those with diabetes mellitus were 19% less likely to die from trauma. Whereas kidney recipients who died via trauma were less likely to have experienced graft loss, trauma deaths in the liver group were more common among those with a history of graft loss. The total number of trauma deaths in the pancreas cohort (n=13) was too small to run logistic regression analysis.
Conclusions: Certain demographic characteristics including White race and male sex are associated with increased risk for trauma death among kidney and liver transplant recipients. Advancing age was associated with a decreased risk in these two cohorts. We believe these findings may help identify patients at risk for trauma death and provide opportunities for early intervention to prevent unnecessary loss of life.
right-click to download