Quantifying Differential Infection Risks in HLA- and/or ABO- Incompatible Kidney Transplant Recipients

R. Avery¹, R. Montgomery², J. Motter¹, A. Massie¹, E. Kraus¹, K. Marr¹, B. Lonze², N. Alachkar¹, K. Jackson¹, M. Holechek¹, D. Ostrander¹, N. Desai¹, M. Waldram¹, S. Shoham¹, S. Mehta¹, J. Hiller¹, J. Langlee¹, S. Young¹, D. Segev¹, J. Garonzik Wang¹

¹Johns Hopkins, Baltimore, MD, ²New York University, New York, NY

Meeting: 2019 American Transplant Congress

Abstract number: 459

Keywords: Infection, Kidney transplantation, Plasmapheresis, Risk factors

Session Information

Session Name: Concurrent Session: Novel Insights in Kidney Infections

Session Type: Concurrent Session

Date: Tuesday, June 4, 2019

Session Time: 2:30pm-4:00pm

Presentation Time: 2:30pm-2:42pm

Location: Room 311

*Purpose: Desensitization has enabled kidney transplantation across HLA-and/or ABO barriers and has conferred survival benefit to patients who lack compatible living donors (CLDKT). However, due to increased immunosuppression relative to CLDKT, incompatible living donor kidney transplant recipients (ILDKT) are at increased risk to experience severe and recurrent infections post-transplant.

*Methods: We identified 296 LDKT recipients from our institution’s incompatible kidney transplant program from 2010 and 2014. Recipients were categorized into ILDKT groups by intensity of desensitization: none/CLDKT (no plasmapheresis; n=107), low (1-4 plasmaphereses; n=40), moderate (5-9 phereses, n=71), high (≥10 phereses; n=78). Data were collected on demographics, transplant characteristics, desensitization regimens, and type of infection. We used multivariable Poisson regression to evaluate the association between strength of desensitization and rate of infection.

*Results: At 1-year post-transplant, 34.4%, 20.6%, 13.3%, and 12.7% of ILDKT recipients developed urinary tract, bloodstream, C. difficile, and pneumonia infections compared to 29.9%, 10.3%, 3.7%, and 4.7% of CLDKT recipients (p for all comparisons <0.05). In the first year, 10.1% and 3.7% of ILDKT recipients had between 5-9 infections and ≥10 infections compared to 3.7% and 0.0% for CLDKT patients (p=0.005). Compared CLDKT, ILDKT recipients with low-intensity (adjusted Incidence Rate Ratio [aIRR]: _0.67 1.14 _1.92, p=0.6), or moderate-intensity (aIRR: _0.79 1.17 _1.74, p=0.4) desensitization had comparable risk, but those who received high-intensity desensitization had a 2.6-fold increase in infection rate (aIRR: _1.77 2.62 _3.88, p<0.001). We found no evidence of difference between desensitization intensity and incidence of BK virus or other opportunistic infections.

*Conclusions: ILDKT recipients who undergo high-intensity desensitization are at increased risk to develop infections post-transplant compared to CLDKT patients. Further study of risk factors for these disparate infection outcomes will be important in designing strategies to protect patients from the cumulative morbidity of recurrent infections, and to extend the survival benefit across the spectrum of ILDKT recipients.

To cite this abstract in AMA style:

Avery R, Montgomery R, Motter J, Massie A, Kraus E, Marr K, Lonze B, Alachkar N, Jackson K, Holechek M, Ostrander D, Desai N, Waldram M, Shoham S, Mehta S, Hiller J, Langlee J, Young S, Segev D, Wang JGaronzik. Quantifying Differential Infection Risks in HLA- and/or ABO- Incompatible Kidney Transplant Recipients [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/quantifying-differential-infection-risks-in-hla-and-or-abo-incompatible-kidney-transplant-recipients/. Accessed May 18, 2025.

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