Attias Philippe, Melica Giovanna, Boutboul David, De Castro Nathalie, Audard Vincent, Stehlé Thomas, Gaube Géraldine, Fourati Slim, Botterel Françoise, Fihman Vincent, Audureau Etienne, Grimbert Philippe, Matignon Marie
AP-HP (Assistance Publique-Hôpitaux de Paris), Nephrology and Renal Transplantation Department, Groupe Hospitalier Henri-Mondor/Albert-Chenevier, 94010 Créteil, France.
AP-HP (Assistance Publique-Hôpitaux de Paris), Infectious Disease Department, Groupe Hospitalier Henri-Mondor/Albert Chenevier, 94010 Créteil, France.
J Clin Med. 2019 Apr 30;8(5):594. doi: 10.3390/jcm8050594.
Epidemiology of opportunistic infections (OI) after kidney allograft transplantation in the modern era of immunosuppression and the use of OI prevention strategies are poorly described. We retrospectively analyzed a single-center cohort on kidney allograft adult recipients transplanted between January 2008 and December 2013. The control group included all kidney recipients transplanted in the same period, but with no OI. We analyzed 538 kidney transplantations (538 patients). The proportion of OI was 15% (80 and 72 patients). OI occurred 12.8 (6.0-31.2) months after transplantation. Viruses were the leading cause ( = 54, (10%)), followed by fungal ( = 15 (3%)), parasitic ( = 6 (1%)), and bacterial ( = 5 (0.9%)) infections. Independent risk factors for OI were extended criteria donor (2.53 (1.48-4.31), = 0.0007) and BK viremia (6.38 (3.62-11.23), < 0.0001). High blood lymphocyte count at the time of transplantation was an independent protective factor (0.60 (0.38-0.94), = 0.026). OI was an independent risk factor for allograft loss (2.53 (1.29-4.95), = 0.007) but not for patient survival. Post-kidney transplantation OIs were mostly viral and occurred beyond one year after transplantation. Pre-transplantation lymphopenia and extended criteria donor are independent risk factors for OI, unlike induction therapy, hence the need to adjust immunosuppressive regimens to such transplant candidates.
在免疫抑制的现代时代，肾移植后机会性感染（OI）的流行病学以及OI预防策略的使用情况鲜有描述。我们回顾性分析了2008年1月至2013年12月间接受肾移植的成年受者的单中心队列。对照组包括同期接受肾移植但无OI的所有受者。我们分析了538例肾移植（538例患者）。OI的发生率为15%（80例和72例患者）。OI发生在移植后12.8（6.0 - 31.2）个月。病毒是主要病因（n = 54，（10%）），其次是真菌（n = 15（3%））、寄生虫（n = 6（1%））和细菌（n = 5（0.9%））感染。OI的独立危险因素是扩大标准供体（2.53（1.48 - 4.31），P = 0.0007）和BK病毒血症（6.38（3.62 - 11.23），P < 0.0001）。移植时高血淋巴细胞计数是独立保护因素（0.60（0.38 - 0.94），P = 0.026）。OI是移植肾丢失的独立危险因素（2.53（1.29 - 4.95），P = 0.007），但不是患者生存的危险因素。肾移植后的OI大多为病毒感染，且发生在移植后一年以上。移植前淋巴细胞减少和扩大标准供体是OI的独立危险因素，与诱导治疗不同，因此需要针对此类移植受者调整免疫抑制方案。
