Development of a Kidney Transplant-Specific DOOR for Urinary Tract Infections Assessing the Impact of Carbapenem Resistance

Authors

• Giulia Soska Baldissera, Medical Sciences Post-Graduation Program, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil.
• Sarah B. Doernberg, Division of Infectious Diseases, University of California, San Francisco, California, USA.
• David van Duin, Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
• Toshimitsu Hamasaki, The Biostatistics Center and the Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Bethesda, Maryland, USA.
• Yijie He, The Biostatistics Center and the Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Bethesda, Maryland, USA.
• Vinícius da Gregory, Universidade Federal do Rio Grande do Sul, Medical School, Porto Alegre, Brazil.
• Murilo Martini, Infectious Diseases Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
• Maria Helena Rigatto, Medical Sciences Post-Graduation Program, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil.
• Scott R. Evans, The Biostatistics Center and the Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Bethesda, Maryland, USA.

Document Type

Journal Article

Publication Date

2-26-2026

Journal

Transplant infectious disease : an official journal of the Transplantation Society

DOI

10.1111/tid.70191

Keywords

Desirability of Outcome Ranking (DOOR); Gram‐negative; carbapenem resistance; kidney transplantation; urinary tract infection

Abstract

BACKGROUND: Urinary tract infections (UTIs) in kidney transplant (KT) recipients are frequent and associated with increased morbidity and mortality. Traditional outcome measures may underestimate its true clinical burden. The Desirability of Outcome Ranking (DOOR), developed by the Antibacterial Resistance Leadership Group, is a patient-centered composite outcome designed to capture the full spectrum of infectious complications. METHODS: We refined the DOOR framework for complicated UTIs by incorporating transplant-specific variables and evaluated its application in a cohort of KT recipients with UTIs between 2013 and 2023. RESULTS: Ninety-seven patients with carbapenem-resistant (CR) UTIs were matched 1:1 by infection year to patients with carbapenem-susceptible (CS) infections. Compared with the standard cUTI DOOR, the KT-UTI DOOR reclassified 41 patients to worse outcome ranks. Using the KT-UTI DOOR, the probability of a more favorable outcome in CR versus CS infections was 41.3% (95% CI: 34.2%-48.7%, p = 0.02) in the unadjusted analysis and 43.4% (95% CI: 36.2%-50.9%, p = 0.08) after adjustment. Transplant-related complications were the only events independently associated with CR infections. In contrast, using the established cUTI DOOR, the corresponding probability was 45.8% (95% CI: 38.8%-52.9%, p = 0.24) in the adjusted analysis. CONCLUSION: Incorporating transplant-related variables improves the clinical relevance of DOOR in KT recipients.

APA Citation

Baldissera, Giulia Soska; Doernberg, Sarah B.; van Duin, David; Hamasaki, Toshimitsu; He, Yijie; Gregory, Vinícius da; Martini, Murilo; Rigatto, Maria Helena; and Evans, Scott R., "Development of a Kidney Transplant-Specific DOOR for Urinary Tract Infections Assessing the Impact of Carbapenem Resistance" (2026). GW Authored Works. Paper 8663.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/8663

Department

Biostatistics and Bioinformatics