Infectious complications and graft outcome following treatment of acute antibody-mediated rejection after kidney transplantation: A nationwide cohort study.

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State: Public
Version: Final published version
License: CC BY 4.0
Serval ID
serval:BIB_8D676A182CA8
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Infectious complications and graft outcome following treatment of acute antibody-mediated rejection after kidney transplantation: A nationwide cohort study.
Journal
PloS one
Author(s)
Perrottet N., Fernández-Ruiz M., Binet I., Dickenmann M., Dahdal S., Hadaya K., Müller T., Schaub S., Koller M., Rotman S., Moll S., Hopfer H., Venetz J.P., Aubert V., Bühler L., Steiger J., Manuel O., Pascual M., Golshayan D.
Working group(s)
and the Swiss Transplant Cohort Study (STCS)
ISSN
1932-6203 (Electronic)
ISSN-L
1932-6203
Publication state
Published
Issued date
2021
Peer-reviewed
Oui
Volume
16
Number
4
Pages
e0250829
Language
english
Notes
Publication types: Journal Article
Publication Status: epublish
Abstract
Acute antibody-mediated rejection (AMR) remains a challenge after kidney transplantation (KT). As there is no clear-cut treatment recommendation, accurate information on current therapeutic strategies in real-life practice is needed. KT recipients from the multicenter Swiss Transplant Cohort Study treated for acute AMR during the first post-transplant year were included retrospectively. We aimed at describing the anti-rejection protocols used routinely, as well as patient and graft outcomes, with focus on infectious complications. Overall, 65/1669 (3.9%) KT recipients were treated for 75 episodes of acute AMR. In addition to corticosteroid boluses, most common therapies included plasmapheresis (56.0%), intravenous immunoglobulins (IVIg) (38.7%), rituximab (25.3%), and antithymocyte globulin (22.7%). At least one infectious complication occurred within 6 months from AMR treatment in 63.6% of patients. Plasmapheresis increased the risk of overall (hazard ratio [HR]: 2.89; P-value = 0.002) and opportunistic infection (HR: 5.32; P-value = 0.033). IVIg exerted a protective effect for bacterial infection (HR: 0.29; P-value = 0.053). The recovery of renal function was complete at 3 months after AMR treatment in 67% of episodes. One-year death-censored graft survival was 90.9%. Four patients (6.2%) died during the first year (two due to severe infection). In this nationwide cohort we found significant heterogeneity in therapeutic approaches for acute AMR. Infectious complications were common, particularly among KT recipients receiving plasmapheresis.
Pubmed
Web of science
Open Access
Yes
Create date
03/05/2021 7:48
Last modification date
24/07/2021 6:34
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