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)
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abstract
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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.
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citation
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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.
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type
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journal paper/review (English)
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date of publishing
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30-04-2021
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journal title
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PLoS One (16/4)
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ISSN electronic
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1932-6203
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pages
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e0250829
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PubMed
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33930037
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DOI
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10.1371/journal.pone.0250829
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