*Purpose: Multimodal therapeutic strategies used to treat acute antibody-mediated rejection (AMR) could enhance the risk of infection. However, data in this context are scarce.

*Methods: We included all kidney transplant (KT) recipients from the Swiss Transplant Cohort Study (STCS) who received a treatment for an acute AMR episode occurring in the first post-transplant year (2008-2014). We aimed at describing the occurrence of infectious complications and at analyzing the impact of the different therapeutic strategies on the incidence of infection after AMR treatment.

*Results: Over 6 years, 66/1669 (4%) KT recipients were treated for an acute AMR episode occurring in the first post-transplant year. 60.6% (40/66) experienced at least one infectious complication within the first 6 months after AMR treatment. There were 96 episodes of infection (2.4 episodes per patient). Bacterial infections were the most frequent complication (56.3%), followed by viral (33.3%) and fungal infections (10.4%). Two patients (3.1%) died due to infectious complications. In a multivariate analysis, plasmapheresis was the only risk factor predicting the occurrence of overall infection (HR: 2.89; 95%CI: 1.46-5.74; P=0.002). Use of rituximab was associated with a higher risk for bacterial infection (HR: 6.57; 95%CI: 2.09-20.71; P=0.001) and use of intravenous immunoglobulins (IVIG) exerted a protective effect (HR: 0.29; 95%CI: 0.08-1.02; P=0.053).

*Conclusions: Infectious complications were common after AMR treatment, although infection-associated mortality was low. Plasmapheresis and rituximab were associated with an increased risk of infection whereas IVIG may reduce the incidence of bacterial infection. Our findings highlight the differential impact of the therapeutic strategies used to treat acute AMR on the risk of infectious complications.

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