Ronsin Charles, Chaba Anis, Suchanek Ondrej, Coindre Jean-Philippe, Kerleau Clarisse, Garandeau Claire, Houzet Aurélie, Cantarovich Diego, Dantal Jacques, Blancho Gilles, Giral Magali, Couvrat-Desvergnes Grégoire, Ville Simon
Department of Nephrology and Immunology, Center Hospitalier Universitaire de Nantes, Nantes, France.
Paris University, Paris, France.
Kidney Int Rep. 2022 Feb 3;7(4):867-875. doi: 10.1016/j.ekir.2022.01.1062. eCollection 2022 Apr.
Cyst infection is a known complication of autosomal dominant polycystic kidney disease (ADPKD). Here, we describe incidence, risk factors, clinical presentation, and outcomes of cyst infection in kidney transplant recipient.
We conducted a single-center retrospective cohort study of patients with ADPKD with renal allografts between January 1, 2009, and October 31, 2020. Cyst infection diagnosis was based on previously described clinical and radiological criteria, using positron emission tomography when available.
A total of 296 patients with ADPKD with renal allografts were included, and 21 patients experienced 22 episodes of cyst infection over a median follow-up of 4 (2-7) years. The cumulative incidence rate was 3% at 1 year, 6 % at 5 years, and 12% at 10 years after transplantation. In multivariate analysis, history of cyst infection before transplantation was the only significant risk factor identified to predict the occurrence of cyst infection after kidney transplantation (hazard ratio [HR] 3.47, 95% CI 1.29-9.31). The clinical presentation at diagnosis of cyst infection included isolated fever in 5 (23%) episodes, acute kidney injury in 12 (55%), and severe sepsis/septic shock in 3 (14%) episodes. Among the 16 (73%) episodes with culture positivity, was the most common pathogen. There was no difference between early (≤1 year after transplantation) and late (>1 year) cyst infection episodes in terms of clinical presentation and outcomes. Cyst infection was significantly associated with graft loss (HR 3.93, 95% CI 1.21-12.80), but no causal relationship could be established.
Incidence of cyst infection in ADPKD after kidney transplantation is low, history of cyst infection representing the main risk factor.
囊肿感染是常染色体显性多囊肾病（ADPKD）的一种已知并发症。在此，我们描述肾移植受者囊肿感染的发病率、危险因素、临床表现及转归。
我们对2009年1月1日至2020年10月31日期间接受同种异体肾移植的ADPKD患者进行了一项单中心回顾性队列研究。囊肿感染的诊断基于先前描述的临床和影像学标准，必要时使用正电子发射断层扫描。
共纳入296例接受同种异体肾移植的ADPKD患者，在中位随访4（2-7）年期间，21例患者发生了22次囊肿感染。移植后1年累积发病率为3%，5年为6%，10年为12%。多因素分析显示，移植前囊肿感染史是预测肾移植后囊肿感染发生的唯一显著危险因素（风险比[HR]3.47，95%置信区间1.29-9.31）。囊肿感染诊断时的临床表现包括5次（23%）为单纯发热，12次（55%）为急性肾损伤，3次（14%）为严重脓毒症/感染性休克。在16次（73%）培养阳性的感染中，[病原体未明确]是最常见的病原体。早期（移植后≤1年）和晚期（>1年）囊肿感染在临床表现和转归方面无差异。囊肿感染与移植肾丢失显著相关（HR 3.93，95%置信区间1.21-12.80），但无法确定因果关系。
肾移植后ADPKD患者囊肿感染的发病率较低，囊肿感染史是主要危险因素。
