Opportunistic Infections after Kidney Transplantation Are Independent Risk Factor of Kidney Allograft Loss: A Retrospective Cohort Study
1Nephrology Transplantation, APHP Henri Mondor, Créteil, France
2Infectious Diseases, APHP Henri Mondor, Créteil, France
3Public Health, APHP Henri Mondor, Créteil, France
4Infectious Diseases, APHP Saint-Louis, Paris, France
5Immunology, APHP Saint-Louis, Paris, France.
Meeting: 2018 American Transplant Congress
Abstract number: A182
Keywords: Immunosuppression, Infection
Session Information
Session Name: Poster Session A: Kidney Transplant Goes Viral
Session Type: Poster Session
Date: Saturday, June 2, 2018
Session Time: 5:30pm-7:30pm
Presentation Time: 5:30pm-7:30pm
Location: Hall 4EF
Background
Currently, kidney allograft survival improved, use of depleting antibodies increased and
donor and recipient became older. In this context, no recent study reported epidemiology of opportunistic infections (OI) after kidney transplant neither the impact of OI on patient and allograft survival.
Materials/Methods
We performed a monocentric retrospective study including kidney allografts recipients engrafted between January 2008 and December 2013 besides primary non-function. Endpoints were OI epidemiology, patient and kidney allograft survivals and risk factors of OI. Control group included all the others kidney recipients.
Results
We included 538 kidney transplantations in 538 patients. Incidence of OI was 14.8% (N=80). The leading cause was viral (N=54; 67.5%) with N=21 herpes zoster (27.5%) and N=19 BK nephropathy (23.8%). Other causes were fungal (N=15, 19%), parasitic (N=6, 7.5%) and bacterial (N=5, 6%). Most of OI occurred more than one year after transplant (N=47, 59% – 12.5 (5.7-30) months). Recipients with IO were significantly older (P=0.006) and with extended criteria donors (ECD) (P<0.0001). However, induction and maintenance immunosuppressive therapy was similar. ECD was an independant risk factor of OI (OR 3.26; P < 0.0001) while lymphocytes count at the time of transplant was protective (OR 0.56; P=0.014).
Kaplan Meier analysis showed that patient (P=0.001) and allograft survival (P=0.001) after OI were significantly lower. OI was an independent risk factor of kidney allograft survival [Table 1], but not an independent risk factor of patient survival.
| HR (CI 95%) | p-value | |
| CD4 T-cells before transplant | 0.25 (0.09-0.72) | 0.010 |
| IO | 3.24 (1.76-5.98) | 0.0002 |
| DSA | 2.32 (1.23-4.39) | 0.010 |
| Diabetes | 1.89 (1.13-3.17) | 0.015 |
| Donor age | 1.02 (1.01-1.04) | 0.009 |
| Donor CMV+ | 1.7 (1-2.89) | 0.049 |
Conclusions
We showed that OI after kidney transplantation were mostly viral without impact of immunosuppressive therapy. OI was an independent risk factors of allograft loss.
CITATION INFORMATION: Attias P., Melica G., Audureau E., Boutboul D., De Castro N., Gallien S., Grimbert P., Matignon M. Opportunistic Infections after Kidney Transplantation Are Independent Risk Factor of Kidney Allograft Loss: A Retrospective Cohort Study Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Attias P, Melica G, Audureau E, Boutboul D, Castro NDe, Gallien S, Grimbert P, Matignon M. Opportunistic Infections after Kidney Transplantation Are Independent Risk Factor of Kidney Allograft Loss: A Retrospective Cohort Study [abstract]. https://atcmeetingabstracts.com/abstract/opportunistic-infections-after-kidney-transplantation-are-independent-risk-factor-of-kidney-allograft-loss-a-retrospective-cohort-study/. Accessed November 21, 2024.« Back to 2018 American Transplant Congress