Infectious Complications of Induction Therapies in Kidney Transplantation

Abstract

Background Cytomegalovirus (CMV) and BK virus (BKV) are post-transplant opportunistic viral infections that affect patient and graft survival. This study was designed to evaluate the risk of BKV nephropathy and CMV disease in kidney transplant recipients who received induction therapy with ATG or basiliximab. Material/Methods We retrospectively analyzed information on 257 adult patients who underwent kidney transplantation between January 2007 and 2017. Patients were categorized into 3 groups according to the induction therapies . The primary endpoint was the onset of CMV disease or biopsy-confirmed BKV nephropathy. The secondary endpoints were biopsy-proven rejection episodes, graft loss, loss to follow-up, and death. Results We followed 257 patients for a median of 55.5 months. The incidence of CMV disease was significantly higher in the only ATG group compared to the group without induction treatment (p<0.001). There was no significant difference in the incidence of BKV nephropathy among groups (p>0.05). The dosage of ATG (OR, 10.685; 95% CI, 1.343 5 to 85.009; P=0.025) was independent risk factor for death. Conclusions This study demonstrated that a higher dosage of ATG in high-risk patients is associated with an increased risk of CMV disease and patient death, also, reducing the dosage may be a rational strategy for increasing graft and patient’s survival.

The Impact of Different Induction Immunosuppressive Therapy on Long Term Kidney Transplant Function When Measured by Iothalamate Clearance

“…In this study, we analyzed the incidence of viral infection, mainly CMV and BK, among the 3 groups of patients based on the induction agent. Multiple studies have shown an increased risk of viral infection when T-cell depleting agent is used for induction therapy versus Basiliximab [28][29][30]. However, we found no significant difference in the incidence of either CMV or BKV disease among the different induction groups.…”

COVİD-19 infection in a membranous nephropathy patient treated with rituximab

“…The most common pattern is ground glass appearance [ 7 ]. Opportunistic infections are common in immunocompromised patients [ 8 ] and symptoms often become blurred even in typical infectious diseases in these patients. Also, the disease course tends to be heavier in these patients compared to healthy population [ 9 ].…”

Tailored immunosuppression after kidney transplantation - a single center real-life experience

“…This study retrospectively tested the efficacy of a tailored immunosuppression approach in kidney transplant recipients with risk-stratified treatment protocols for five different patient categories in our center. The main findings are the following: (1) we observed excellent patient and allograft survival rates at 1 and 4 years post-transplant; (2) we found no differences between sensitized patients (ABO compatible versus incompatible, DSA positive versus DSA negative) regarding acute rejection rates and graft survival; (3) compared with a historical control group at our center there was a significant reduction of antibody- and T cell- mediated rejection in sensitized thymoglobulin-treated patients; (4) there was no increased rate of infections leading to hospitalization among patients receiving thymoglobulin, but an increased incidence of CMV viremia, as confirmed by a recent Cochrane database review [ 22 , 23 ].…”