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

Publication

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

Journal Paper/Review - Apr 30, 2021

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

Citation

Perrottet N, Hopfer H, Venetz J, Aubert V, Buhler L, Steiger J, Manuel O, Pascual M, Golshayan D, Moll S, Rotman S, Fernández-Ruiz M, Binet F, Dickenmann M, Dahdal S, Hadaya K, Müller T, Schaub S, Koller M, 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)

Journal

PloS one 2021; 16

Publication Date

Apr 30, 2021

Issn Electronic

1932-6203

Pages

e0250829

Brief description/objective

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.