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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...
Autores principales: | , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2021
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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. |
format | Online Article Text |
id | pubmed-8087104 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
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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