Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière Hospital, Medical and Surgical Department of Kidney Transplantation, Paris, France.
Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière Hospital, Department of Infectious and Tropical Diseases, Paris, France.
Transpl Int. 2023 Jan 18;36:10765. doi: 10.3389/ti.2023.10765. eCollection 2023.
Kidney transplant recipients develop atypical infections in their epidemiology, presentation and outcome. Among these, meningitis and meningoencephalitis require urgent and adapted anti-infectious therapy, but published data is scarce in KTRs. The aim of this study was to describe their epidemiology, presentation and outcome, in order to improve their diagnostic and management. We performed a retrospective, multicentric cohort study in 15 French hospitals that included all 199 cases of M/ME in KTRs between 2007 and 2018 (0.9 case per 1,000 KTRs annually). Epidemiology was different from that in the general population: 20% were due to , 13.5% to varicella-zoster virus, 5.5% to , and 4.5% to Enterobacteria (half of which produced extended spectrum beta-lactamases), and 5% were Post Transplant Lymphoproliferative Disorders. Microorganisms causing M/ME in the general population were infrequent (2%, for ) or absent (). M/ME caused by Enterobacteria, or filamentous fungi were associated with high and early mortality (50%-70% at 1 year). Graft survival was not associated with the etiology of M/ME, nor was impacted by immunosuppression reduction. Based on these results, we suggest international studies to adapt guidelines in order to improve the diagnosis and the probabilistic treatment of M/ME in SOTRs.
肾移植受者在其流行病学、表现和结局中出现非典型感染。其中，脑膜炎和脑膜脑炎需要紧急和适当的抗感染治疗，但在肾移植受者中发表的数据很少。本研究的目的是描述其流行病学、表现和结局，以改善其诊断和管理。我们在 15 家法国医院进行了一项回顾性、多中心队列研究，该研究纳入了 2007 年至 2018 年间所有 199 例肾移植受者的 M/ME 病例（每年每 1000 例肾移植受者中有 0.9 例）。流行病学与普通人群不同：20%由引起，13.5%由水痘带状疱疹病毒引起，5.5%由引起，4.5%由肠杆菌引起（其中一半产生超广谱β-内酰胺酶），5%为移植后淋巴细胞增生性疾病。在普通人群中引起 M/ME 的微生物很少见（2%，为）或不存在（）。由肠杆菌、或丝状真菌引起的 M/ME 与高早期死亡率相关（1 年时为 50%-70%）。移植物存活率与 M/ME 的病因无关，也不受免疫抑制减少的影响。基于这些结果，我们建议进行国际研究，以调整指南，以便改善 SOTR 中 M/ME 的诊断和概率治疗。
