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Treatment of Chronic Active Antibody-mediated Rejection With Pulse Steroids, IVIG, With or Without Rituximab is Associated With Increased Risk of Pneumonia

BACKGROUND. The risk of infection associated with specific treatments of chronic active antibody-mediated rejection (cAMR) after kidney transplantation remains unknown. METHODS. This was a single-center study of kidney transplant recipients treated with pulse steroids, intravenous immunoglobulin (IV...

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Autores principales: Joachim, Emily, Parajuli, Sandesh, Swanson, Kurtis J., Aziz, Fahad, Garg, Neetika, Mohamed, Maha, Mandelbrot, Didier, Djamali, Arjang
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7738046/
https://www.ncbi.nlm.nih.gov/pubmed/33335983
http://dx.doi.org/10.1097/TXD.0000000000001080
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author Joachim, Emily
Parajuli, Sandesh
Swanson, Kurtis J.
Aziz, Fahad
Garg, Neetika
Mohamed, Maha
Mandelbrot, Didier
Djamali, Arjang
author_facet Joachim, Emily
Parajuli, Sandesh
Swanson, Kurtis J.
Aziz, Fahad
Garg, Neetika
Mohamed, Maha
Mandelbrot, Didier
Djamali, Arjang
author_sort Joachim, Emily
collection PubMed
description BACKGROUND. The risk of infection associated with specific treatments of chronic active antibody-mediated rejection (cAMR) after kidney transplantation remains unknown. METHODS. This was a single-center study of kidney transplant recipients treated with pulse steroids, intravenous immunoglobulin (IVIG) ± rituximab for biopsy-confirmed cAMR. The control group consisted of age- and race-matched patients who underwent donor-specific antibody-based protocol biopsies but had no rejection. We collected data on BK virus (BKV), cytomegalovirus (CMV), urinary tract infection (UTI), and pneumonia postbiopsy. RESULTS. There were 49 patients in each group. In those with cAMR, 21 (43%) were treated with steroids, IVIG, and rituximab; the remaining received steroids and IVIG only. The risk of graft failure was greater in the cAMR group [22 (45%) vs. 3 (6%), P < 0.001]. Kaplan-Meier analyses demonstrated a significantly greater risk of pneumonia in the cAMR group (P = 0.02). This was confirmed by multivariable Cox regression analyses [Hazard ratio (HR) = 6.04, P = 0.027, 95% CI, 1.22-29.75]. None of the patients with pneumonia were affected by opportunistic pathogens. Additionally, the risk of CMV, UTI, and BKV was not increased. Rituximab was not independently associated with any of the infections studied. CONCLUSIONS. Treatment of cAMR, but not rituximab, was associated with a 6-fold increased risk of pneumonia. Additional studies are needed to determine the safety and efficacy of prolonged antimicrobial prophylaxis and monitoring strategies, including for hypogammaglobulinemia, to reduce the risk of pneumonia following the treatment of cAMR.
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spelling pubmed-77380462020-12-16 Treatment of Chronic Active Antibody-mediated Rejection With Pulse Steroids, IVIG, With or Without Rituximab is Associated With Increased Risk of Pneumonia Joachim, Emily Parajuli, Sandesh Swanson, Kurtis J. Aziz, Fahad Garg, Neetika Mohamed, Maha Mandelbrot, Didier Djamali, Arjang Transplant Direct Kidney Transplantation BACKGROUND. The risk of infection associated with specific treatments of chronic active antibody-mediated rejection (cAMR) after kidney transplantation remains unknown. METHODS. This was a single-center study of kidney transplant recipients treated with pulse steroids, intravenous immunoglobulin (IVIG) ± rituximab for biopsy-confirmed cAMR. The control group consisted of age- and race-matched patients who underwent donor-specific antibody-based protocol biopsies but had no rejection. We collected data on BK virus (BKV), cytomegalovirus (CMV), urinary tract infection (UTI), and pneumonia postbiopsy. RESULTS. There were 49 patients in each group. In those with cAMR, 21 (43%) were treated with steroids, IVIG, and rituximab; the remaining received steroids and IVIG only. The risk of graft failure was greater in the cAMR group [22 (45%) vs. 3 (6%), P < 0.001]. Kaplan-Meier analyses demonstrated a significantly greater risk of pneumonia in the cAMR group (P = 0.02). This was confirmed by multivariable Cox regression analyses [Hazard ratio (HR) = 6.04, P = 0.027, 95% CI, 1.22-29.75]. None of the patients with pneumonia were affected by opportunistic pathogens. Additionally, the risk of CMV, UTI, and BKV was not increased. Rituximab was not independently associated with any of the infections studied. CONCLUSIONS. Treatment of cAMR, but not rituximab, was associated with a 6-fold increased risk of pneumonia. Additional studies are needed to determine the safety and efficacy of prolonged antimicrobial prophylaxis and monitoring strategies, including for hypogammaglobulinemia, to reduce the risk of pneumonia following the treatment of cAMR. Lippincott Williams & Wilkins 2020-12-15 /pmc/articles/PMC7738046/ /pubmed/33335983 http://dx.doi.org/10.1097/TXD.0000000000001080 Text en Copyright © 2020 The Author(s). Transplantation Direct. Published by Wolters Kluwer Health, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (http://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
spellingShingle Kidney Transplantation
Joachim, Emily
Parajuli, Sandesh
Swanson, Kurtis J.
Aziz, Fahad
Garg, Neetika
Mohamed, Maha
Mandelbrot, Didier
Djamali, Arjang
Treatment of Chronic Active Antibody-mediated Rejection With Pulse Steroids, IVIG, With or Without Rituximab is Associated With Increased Risk of Pneumonia
title Treatment of Chronic Active Antibody-mediated Rejection With Pulse Steroids, IVIG, With or Without Rituximab is Associated With Increased Risk of Pneumonia
title_full Treatment of Chronic Active Antibody-mediated Rejection With Pulse Steroids, IVIG, With or Without Rituximab is Associated With Increased Risk of Pneumonia
title_fullStr Treatment of Chronic Active Antibody-mediated Rejection With Pulse Steroids, IVIG, With or Without Rituximab is Associated With Increased Risk of Pneumonia
title_full_unstemmed Treatment of Chronic Active Antibody-mediated Rejection With Pulse Steroids, IVIG, With or Without Rituximab is Associated With Increased Risk of Pneumonia
title_short Treatment of Chronic Active Antibody-mediated Rejection With Pulse Steroids, IVIG, With or Without Rituximab is Associated With Increased Risk of Pneumonia
title_sort treatment of chronic active antibody-mediated rejection with pulse steroids, ivig, with or without rituximab is associated with increased risk of pneumonia
topic Kidney Transplantation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7738046/
https://www.ncbi.nlm.nih.gov/pubmed/33335983
http://dx.doi.org/10.1097/TXD.0000000000001080
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