Potential Influencing Factors on Infection Prevention Behaviours in Kidney Transplant Recipients

Abstract

Kidney transplantation is an effective treatment for end-stage renal disease (ESRD), but postoperative infection is one of the main causes of graft kidney failure and patient death (Chen et al. 2024). Prevention and management of post-transplant infections are crucial to improving the success rate of transplantation and the quality of patient survival. The epidemiology and risk factors for post-transplant infections have changed in recent years with advances in immunosuppressive therapies and emerging pathogens (Bharati et al. 2023). Therefore, a deeper understanding of these factors is essential for developing effective prevention strategies. It was reported that the incidence of infections is higher during the first 2 years after kidney transplantation, especially in female patients and those with a history of recurrent urinary tract infections (Alotaibi 2024). A study by Pfirmann et al. (2024) provided epidemiologic trends and risk factors for opportunistic infections in kidney transplant recipients between 2004 and 2017. They found that cytomegalovirus infection was the most predominant opportunistic infection and that syndromes and diseases were significantly associated with post-transplant graft failure and patient mortality (Pfirmann et al. 2024). Therefore, understanding and improving infection prevention behaviours in kidney transplant recipients is essential to enhancing transplant success and patient survival quality.

We read with great interest in a retrospective cross-sectional study (Sarigol and Karakilcik 2024) that investigated the factors affecting the infection prevention behaviours of kidney transplant recipients. The authors found that kidney transplant recipients perform poorly in infection prevention behaviours (e.g., a self-reported hand hygiene rate of only 51%). Older kidney transplant recipients were found more likely to receive pneumonia vaccine and wear masks outdoors. Married patients preferred to rinse vegetables compared to single patients. Last, patients with high levels of self-control and self-management were more proactive in adopting infection prevention behaviours.

Though previous studies have reported specific infection prevention behaviours, few studies have focused on factors affecting these. Sarigol and Karakilcik (2024) innovatively investigated this scientific issue by conducting a cross-sectional study. After carefully reviewing this intriguing article, in addition to the limitations mentioned in this study, we found several other inherent limitations that should be noted when interpreting their findings. First, this study was conducted at only one centre in specific regions, thus the sample may not be sufficiently representative of the behaviours and characteristics of all kidney transplant recipients (e.g., different cultural, living habits and geographic contexts), which limits the generalisability of the study results. Second, since this is a cross-sectional study, data were collected at a single point in time, which may not reflect trends in recipients' infection prevention behaviours over time. Besides, this study design can only provide evidence of the relationship between these factors and infection prevention behaviours, but it was not possible to establish causality. Third, this study relied on self-reported data from respondents, which might lead to social desirability bias, where respondents might report behaviours they believed were socially desirable rather than what they actually did. Also, the self-developed questionnaires used in the study might lack extensive validation, which may have affected the accuracy of the results. Fourth, this study failed to investigate the infection status of recipients, thus the relationship between infection prevention behaviours and actual infection rates could not be determined. Moreover, though the study performed a few multivariate analyses, there might have been unmeasured confounders that could have influenced the relationship between infection prevention behaviours and self-management.

This study establishes a crucial basis for enhancing the understanding of the relationship between the potential influencing factors and infection prevention behaviours in kidney transplant recipients. To improve the quality of the study and the reliability of the results, future studies could take into account the limitations mentioned above and use larger samples, long-term follow-up, objective measurement tools and possibly intervention study designs.

Conception and comment of the study and designed the study, L.Z. and C.C. original draft preparation, L.Z. and J.L. writing – review and editing, L.Z. and C.C. supervision and revise the manuscript, J.L. All authors read and approved the final manuscript.

The authors declare no conflicts of interest.