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

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 t...

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Autores principales: Perrottet, Nancy, Fernández-Ruiz, Mario, Binet, Isabelle, Dickenmann, Michael, Dahdal, Suzan, Hadaya, Karine, Müller, Thomas, Schaub, Stefan, Koller, Michael, Rotman, Samuel, Moll, Solange, Hopfer, Helmut, Venetz, Jean-Pierre, Aubert, Vincent, Bühler, Léo, Steiger, Jurg, Manuel, Oriol, Pascual, Manuel, Golshayan, Dela
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8087104/
https://www.ncbi.nlm.nih.gov/pubmed/33930037
http://dx.doi.org/10.1371/journal.pone.0250829
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author Perrottet, Nancy
Fernández-Ruiz, Mario
Binet, Isabelle
Dickenmann, Michael
Dahdal, Suzan
Hadaya, Karine
Müller, Thomas
Schaub, Stefan
Koller, Michael
Rotman, Samuel
Moll, Solange
Hopfer, Helmut
Venetz, Jean-Pierre
Aubert, Vincent
Bühler, Léo
Steiger, Jurg
Manuel, Oriol
Pascual, Manuel
Golshayan, Dela
author_facet Perrottet, Nancy
Fernández-Ruiz, Mario
Binet, Isabelle
Dickenmann, Michael
Dahdal, Suzan
Hadaya, Karine
Müller, Thomas
Schaub, Stefan
Koller, Michael
Rotman, Samuel
Moll, Solange
Hopfer, Helmut
Venetz, Jean-Pierre
Aubert, Vincent
Bühler, Léo
Steiger, Jurg
Manuel, Oriol
Pascual, Manuel
Golshayan, Dela
author_sort Perrottet, Nancy
collection PubMed
description 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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spelling pubmed-80871042021-05-06 Infectious complications and graft outcome following treatment of acute antibody-mediated rejection after kidney transplantation: A nationwide cohort study Perrottet, Nancy Fernández-Ruiz, Mario Binet, Isabelle Dickenmann, Michael Dahdal, Suzan Hadaya, Karine Müller, Thomas Schaub, Stefan Koller, Michael Rotman, Samuel Moll, Solange Hopfer, Helmut Venetz, Jean-Pierre Aubert, Vincent Bühler, Léo Steiger, Jurg Manuel, Oriol Pascual, Manuel Golshayan, Dela PLoS One Research Article 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. Public Library of Science 2021-04-30 /pmc/articles/PMC8087104/ /pubmed/33930037 http://dx.doi.org/10.1371/journal.pone.0250829 Text en © 2021 Perrottet et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Perrottet, Nancy
Fernández-Ruiz, Mario
Binet, Isabelle
Dickenmann, Michael
Dahdal, Suzan
Hadaya, Karine
Müller, Thomas
Schaub, Stefan
Koller, Michael
Rotman, Samuel
Moll, Solange
Hopfer, Helmut
Venetz, Jean-Pierre
Aubert, Vincent
Bühler, Léo
Steiger, Jurg
Manuel, Oriol
Pascual, Manuel
Golshayan, Dela
Infectious complications and graft outcome following treatment of acute antibody-mediated rejection after kidney transplantation: A nationwide cohort study
title Infectious complications and graft outcome following treatment of acute antibody-mediated rejection after kidney transplantation: A nationwide cohort study
title_full Infectious complications and graft outcome following treatment of acute antibody-mediated rejection after kidney transplantation: A nationwide cohort study
title_fullStr Infectious complications and graft outcome following treatment of acute antibody-mediated rejection after kidney transplantation: A nationwide cohort study
title_full_unstemmed Infectious complications and graft outcome following treatment of acute antibody-mediated rejection after kidney transplantation: A nationwide cohort study
title_short Infectious complications and graft outcome following treatment of acute antibody-mediated rejection after kidney transplantation: A nationwide cohort study
title_sort infectious complications and graft outcome following treatment of acute antibody-mediated rejection after kidney transplantation: a nationwide cohort study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8087104/
https://www.ncbi.nlm.nih.gov/pubmed/33930037
http://dx.doi.org/10.1371/journal.pone.0250829
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