{
  "abstract": "ObjectiveKidney transplant recipients (KTRs) face significantly elevated hospitalization rates, with infections being a leading cause. This study aimed to comprehensively characterize the epidemiology, clinical outcomes, trends, and economic burden of non-graft-failure hospitalizations (NGFHs), with a particular focus on infectious diseases, in a large Chinese KTR cohort over two decades.MethodsThis retrospective multicenter cohort study included all adult KTRs under follow-up at three hospitals in eastern China from 2005 to 2024. Non-graft-failure hospitalizations were defined as admissions for indications other than permanent graft loss requiring return to maintenance dialysis or re-transplantation, and excluding routine surveillance biopsies. The primary outcomes were the causes and rates of hospitalization, length of stay (LOS), in-hospital mortality, and direct medical costs. Hospitalization rates per 100 person-years (PY) were calculated, and multivariable logistic regression with clustered robust standard errors and Firth’s penalized maximum likelihood estimation was performed to identify independent risk factors associated with in-hospital death.ResultsAmong 202 KTRs (mean age 52.1 ± 13.8 years; 60.9% male), 384 NGFHs occurred over 1,814 PY. Among the 202 patients, 128 (63.4%) had a single hospitalization, while 74 (36.6%) had two or more admissions. The overall rate of 21.2 per 100 PY—approximately six-fold higher than previously reported rates for the age-matched general population. Infections were the predominant cause, accounting for 42.2% of all admissions, with pneumonia (9.4%) and urinary tract infections (7.0%) being most frequent. The in-hospital mortality rate was 2.9% (n = 11), and all deaths occurred during infection-related admissions. Sepsis at admission was the strongest independent predictor of death (adjusted OR 34.2, 95% CI 7.8–150.1; sensitivity analysis using Firth’s penalized regression: OR 29.6, 95% CI 8.2–106.5). Deceased patients had significantly longer LOS (median 24 vs. 4 days) and higher costs (¥92,922 vs. ¥7,896; both p < 0.001). The overall hospitalization rate declined after 2015 (24.6 → 17.8/100 PY), driven largely by fewer infection-related admissions.ConclusionInfectious diseases are the leading cause of non-graft-failure hospitalizations and all in-hospital deaths in this cohort occurred during infection-related admissions. Sepsis at admission is a critical prognostic sentinel, mandating immediate protocolized recognition and escalation of care. The post-2015 decline in infection-related admissions provides hypothesis-generating, real-world evidence consistent with the potential effectiveness of multi-modal prevention strategies, which warrant further evaluation.",
  "abstract_shown": true,
  "affiliations": [],
  "article_type": "Original Research",
  "arxiv": null,
  "author_total": 2,
  "authors": [
    {
      "name": "Zheng Yang"
    },
    {
      "name": "Guangbiao Xu"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/56bpx8wem2ch2.bib",
  "cited_by": 0,
  "doi": "10.3389/fpubh.2026.1954413",
  "fulltext_url": null,
  "id": "56bpx8wem2ch2",
  "issns": [
    "2296-2565"
  ],
  "landing_url": "https://www.frontiersin.org/articles/10.3389/fpubh.2026.1954413",
  "language": null,
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "feed-journal",
      "medicine/epidemiology-public-health"
    ]
  ],
  "openalex": null,
  "pdf_url": null,
  "pmcid": null,
  "pmid": null,
  "published": "2026-11-11",
  "publisher": "Frontiers Media SA",
  "ris": "https://research.draconitic.com/paper/56bpx8wem2ch2.ris",
  "sources": [
    {
      "first_seen": "2026-11-11T12:21:07Z",
      "native_id": "10.3389/fpubh.2026.1954413",
      "source": "feed-frontiers",
      "url": "https://www.frontiersin.org/articles/10.3389/fpubh.2026.1954413"
    },
    {
      "first_seen": "2026-11-11T12:26:37Z",
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      "url": "https://www.frontiersin.org/articles/10.3389/fpubh.2026.1954413/full"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "feed-journal:medicine/epidemiology-public-health",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "The infectious disease burden in kidney transplant recipients: a 20-year multicenter cohort study on non-graft-failure hospitalizations in eastern China",
  "title_text": "The infectious disease burden in kidney transplant recipients: a 20-year multicenter cohort study on non-graft-failure hospitalizations in eastern China",
  "type": "peer-reviewed",
  "updated_at": "2026-11-13T00:21:29Z",
  "url": "https://research.draconitic.com/paper/56bpx8wem2ch2",
  "venue": "Frontiers in Public Health",
  "versions": []
}