Gupta Simran, Gea-Banacloche Juan, Heilman Raymond L, Yaman Reena N, Me Hay Me, Zhang Nan, Vikram Holenarasipur R, Kodali Lavanya
Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
Harvard Medical School, Boston, MA, USA.
J Transplant. 2024 Mar 1;2024:6663086. doi: 10.1155/2024/6663086. eCollection 2024.
The impact of renal allograft rejection treatment on infection development has not been formally defined in the literature.
We conducted a retrospective cohort study of 185 rejection (case) and 185 nonrejection (control) kidney transplant patients treated at our institution from 2014 to 2020 to understand the impact of rejection on infection development. Propensity scoring was used to match cohorts. We collected data for infections within 6 months of rejection for the cases and 18 months posttransplant for controls.
In 370 patients, we identified 466 infections, 297 in the controls, and 169 in the cases. Urinary tract infections (38.9%) and cytomegalovirus viremia (13.7%) were most common. Cumulative incidence of infection between the case and controls was 2.17 (CI 1.54-3.05); < 0.001. There was no difference in overall survival (HR 0.90, CI 0.49-1.66) or graft survival (HR 1.27, CI 0.74-2.20) between the groups. There was a significant difference in overall survival (HR 2.28, CI 1.14-4.55; = 0.019) and graft survival (HR 1.98, CI 1.10-3.56; = 0.023) when patients with infection were compared to those without.
As previously understood, rejection treatment is a risk factor for subsequent infection development. Our data have defined this relationship more clearly. This study is unique, however, in that we found that infections, but not rejection, negatively impacted both overall patient survival and allograft survival, likely due to our institution's robust post-rejection protocols. Clinicians should monitor patients closely for infections in the post-rejection period and have a low threshold to treat these infections while also restarting appropriate prophylaxis.
肾移植排斥反应治疗对感染发生的影响在文献中尚未得到正式界定。
我们对2014年至2020年在我院接受治疗的185例发生排斥反应的（病例）和185例未发生排斥反应的（对照）肾移植患者进行了一项回顾性队列研究，以了解排斥反应对感染发生的影响。采用倾向评分法对队列进行匹配。我们收集了病例组排斥反应后6个月内以及对照组移植后18个月内的感染数据。
在370例患者中，我们共识别出466次感染，对照组297次，病例组169次。尿路感染（38.9%）和巨细胞病毒血症（13.7%）最为常见。病例组和对照组之间感染的累积发病率为2.17（可信区间1.54 - 3.05）；P < 0.001。两组之间的总生存率（风险比0.90，可信区间0.49 - 1.66）或移植肾生存率（风险比1.27，可信区间0.74 - 2.20）无差异。与未发生感染的患者相比，发生感染的患者在总生存率（风险比2.28，可信区间1.14 - 4.55；P = 0.019）和移植肾生存率（风险比1.98，可信区间1.10 - 3.56；P = 0.023）方面存在显著差异。
如先前所知，排斥反应治疗是随后发生感染的一个危险因素。我们的数据更清晰地界定了这种关系。然而，本研究的独特之处在于，我们发现感染而非排斥反应对患者总生存率和移植肾生存率均产生负面影响，这可能归因于我院强大的排斥反应后治疗方案。临床医生应在排斥反应后密切监测患者是否发生感染，对于治疗这些感染应保持较低阈值，同时重新启动适当的预防措施。
