This study aims to define the epidemiologic, clinical, and microbiological features of asymptomatic bacteriuria (AB) and cystitis in kidney transplantation recipients (KTRs), and to determine the impact of antimicrobial therapy of AB and the risk factors of cystitis. We conducted a prospective observational study of AB and cystitis in KTRs from January to June 2017. One-hundred ninety seven KTRs were included: 175 (88.8%) with AB and 22 (11.2%) with cystitis. The most frequent etiologies were Escherichia coli, Klebsiellapneumoniae, Enterococcusfaecalis, and Pseudomonas aeruginosa. No differences were observed regarding the etiologies, antimicrobial susceptibility patterns, and microbiologic outcomes in AB vs. cystitis. The treatment of AB diminished the microbiological cure and increased the rates of microbiologic relapses and reinfections; in addition, treated AB patients showed a trend of developing symptomatic urinary tract infection in the following six months. The analysis of the data identified the following independent risk factors for cystitis during the six months of follow-up: AB treatment, thymoglobulin induction, previous acute pyelonephritis, and time since transplantation < 1 year. In summary, considering the lack of clinical benefits of treating AB and its impact on cystitis development in the follow-up, we support the recommendation of not screening for or treating AB.
IntroductionKidney transplant recipients showed a weak humoral response to the mRNA COVID-19 vaccine despite receiving three cumulative doses of the vaccine. New approaches are still needed to raise protective immunity conferred by the vaccine administration within this group of high-risk patients. MethodsTo analyze the humoral response and identify any predictive factors within these patients, we designed a prospective monocentric longitudinal study of Kidney transplant recipients (KTR) who received three doses of mRNA-1273 COVID-19 vaccine. Specific antibody levels were measured by chemiluminescence. Parameters related to clinical status such as kidney function, immunosuppressive therapy, inflammatory status and thymic function were analyzed as potential predictors of the humoral response. ResultsSeventy-four KTR and sixteen healthy controls were included. One month after the administration of the third dose of the COVID-19 vaccine, 64.8% of KTR showed a positive humoral response. As predictive factors of seroconversion and specific antibody titer, we found that immunosuppressive therapy, worse kidney function, higher inflammatory status and age were related to a lower response in KTR while immune cell counts, thymosin-a1 plasma concentration and thymic output were related to a higher humoral response. Furthermore, baseline thymosin-a1 concentration was independently associated with the seroconversion after three vaccine doses. DiscussionIn addition to the immunosuppression therapy, condition of kidney function and age before vaccination, specific immune factors could also be relevant in light of optimization of the COVID-19 vaccination protocol in KTR. Therefore, thymosin-a1, an immunomodulatory hormone, deserves further research as a potential adjuvant for the next vaccine boosters.
BackgroundImmunosuppressive treatment for kidney transplantation is tailored to the clinical and immunological features of donors and recipients.PurposeTo describe the incidence of infection with cytomegalovirus (CMV) after immunosuppressant treatment with rabbit anti-thymocyte globulin (ATG) in kidney transplant patients, and the relationship with CMV serology and ATG dose.Material and methodsA retrospective descriptive study was carried out that included all kidney transplant patients who received ATG immunosuppressant induction treatment in 2012. The following variables were collected:Patient data: weight, sexTransplant data: type of donor: living donor or dead (brain death or asystole)Treatment data: dose and cumulative doseCMV: donor and recipient serology, CMV viral loadAll ATG protocols include ganciclovir or valganciclovir prophylaxis from the third day post-transplant for three months.Results36 patients (25 men) were included. Regarding the type of donor: 19 were from brain death, 12 from asystole and 5 were from living donors.12 of the 36 patients (33.33%) who received ATG developed CMV infection. 20 transplants were donor positive – recipient positive (D+/R+), and 4 of them were infected (20%). 10 patients were (D-/R+) and 3 of them were infected (30%). Only one patient was (D-/R-) and was not infected.The most important result was in the high risk group (D+/R-) because 4 patients were included and all of them developed primary infections. Another R+ patient was infected but we didn’t know the donor serology.No differences were found in the average dose received in infected patients (0.97 mg/kg/day) versus non-infected patients (1.01 mg/kg/day).The dose of ganciclovir and valganciclovir were switched from prophylaxis to treatment until viral load control was achieved in all of them.ConclusionThere was a high percentage of kidney transplant patients with ATG immunosuppression. Despite prophylaxis with ganciclovir or valganciclovir they had CMV infections, mainly in the D+/R- serology group, in which all of them developed CMV infection.No relationship were found with CMV infection and ATG dose received.References and/or AcknowledgementsNo conflict of interest.
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