Burden, Patterns, and associated factors of post-kidney transplant infections among renal transplant recipients in Ethiopia: a retrospective study

Abstract Background Post-kidney transplant infections are a major cause of morbidity, mortality, and healthcare utilization among kidney transplant recipients. Despite this burden, there is limited evidence describing the magnitude, patterns, and associated factors of post-kidney transplant infections in Ethiopia. Methods An institution-based retrospective cross-sectional study was conducted among 203 kidney transplant recipients on follow-up at St Paul Hospital Millennium Medical College, Addis Ababa, Ethiopia. Data were collected from medical records and analyzed using SPSS version 25. Descriptive statistics were used to summarize patient characteristics and infection patterns. Logistic regression analysis was performed to identify factors associated with post-kidney transplant infections. Results Overall, 155(76.4%) recipients developed 348 infection episodes during follow-up, corresponding to an incidence rate of 62.52 per 100 person-years. The incidence was higher during the first year post-transplant and declined thereafter; however, a substantial proportion of infections occurred beyond six months. The most common clinical diagnoses were acute gastroenteritis, urinary tract infection, and community-acquired pneumonia. Bacterial pathogens were the most frequently identified, although most infections were diagnosed clinically. Tuberculosis was observed in 1.4% of recipients. In multivariable analysis, residence in Addis Ababa was associated with higher odds of detected infection (AOR = 2.4, 95%CI: 1.08–5.35). Conclusion A high burden of post-kidney transplant infections was observed, with frequent recurrent episodes and a predominance of bacterial infections. The association between urban residence and infection should be interpreted cautiously, as it may reflect differences in healthcare access and diagnostic practices. These findings highlight the need for improved context-specific strategies for infection monitoring and management in kidney transplant recipients.