Yahav Dafna, Sulimani Omri, Green Hefziba, Margalit Ili, Ben-Zvi Haim, Mor Eytan, Rozen-Zvi Benaya
Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.
Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel.
Clin Transplant. 2019 Oct;33(10):e13707. doi: 10.1111/ctr.13707. Epub 2019 Sep 19.
Immunosuppression reduction is a common practice in the management of bacterial infection among kidney transplant recipients (KTRs). This practice, however, is based on limited evidence.
Retrospective study comparing clinical outcomes of KTRs whose antimetabolite was discontinued vs continued during hospitalization due to bacterial infection, considering calcineurin inhibitors (CNI) levels. Primary outcome was a composite of clinical failure at day 5; all-cause mortality; and/or re-hospitalization at 90 days. Multivariable analysis of risk factors for the primary outcome was performed using a propensity-matched cohort.
We included 183 KTRs hospitalized with bacterial infection. Neither discontinuation of antimetabolites nor lower levels of CNI at infection onset were associated with a significant decrease the composite primary outcome. No significant difference in graft loss or rejection was demonstrated between patients with low vs high CNI levels or discontinuation vs continuation of antimetabolite. In multivariable analysis, CNI levels and management of antimetabolite were not significantly associated with adverse outcome.
Immunosuppression reduction in hospitalized KTRs with bacterial infection did not offer a clinical advantage in terms of mortality, re-hospitalization, or clinical success. An interventional study evaluating continuation of immunosuppression vs reduction should be considered.
在肾移植受者（KTRs）的细菌感染管理中，减少免疫抑制是一种常见做法。然而，这种做法的证据有限。
进行回顾性研究，比较因细菌感染住院期间停用与继续使用抗代谢药物的KTRs的临床结局，并考虑钙调神经磷酸酶抑制剂（CNI）水平。主要结局是第5天临床失败、全因死亡率和/或90天内再次住院的综合情况。使用倾向匹配队列对主要结局的危险因素进行多变量分析。
我们纳入了183例因细菌感染住院的KTRs。抗代谢药物的停用或感染发作时较低的CNI水平均与综合主要结局的显著降低无关。低CNI水平与高CNI水平患者之间，或抗代谢药物停用与继续使用患者之间，在移植物丢失或排斥反应方面无显著差异。在多变量分析中，CNI水平和抗代谢药物的管理与不良结局无显著关联。
对于因细菌感染住院的KTRs，减少免疫抑制在死亡率、再次住院或临床成功率方面未显示出临床优势。应考虑开展一项评估免疫抑制继续使用与减少使用的干预性研究。
