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

Nancy Perrottet, Mario Fernández-Ruiz, Isabelle Binet, Michael Dickenmann, Suzan Dahdal, Karine Hadaya, Thomas Müller, Stefan Schaub, Michael Koller, Samuel Rotman, Solange Moll, Helmut Hopfer, Jean-Pierre Venetz, Vincent Aubert, Léo Bühler, Jürg Steiger, Oriol Manuel, Manuel Pascual, Dela Golshayan & The Swiss Transplant Cohort Study (STCS)

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.
   
citation 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, The Swiss Transplant Cohort Study (STCS) . Infectious complications and graft outcome following treatment of acute antibody-mediated rejection after kidney transplantation: A nationwide cohort study. PLoS One 2021; 16:e0250829.
   
type journal paper/review (English)
date of publishing 30-04-2021
journal title PLoS One (16/4)
ISSN electronic 1932-6203
pages e0250829
PubMed 33930037
DOI 10.1371/journal.pone.0250829