Esnault V, Hoisnard L, Peiffer B, Fihman V, Fourati S, Angebault C, Champy C, Gallien S, Attias P, Morel A, Grimbert P, Melica G, Matignon M
Assistance Publique-Hôpitaux de Paris (AP-HP), Service de Maladies Infectieuses et d'Immunologie Clinique, Centre Hospitalo-Universitaire (CHU) Henri Mondor, Créteil, France.
Fédération Hospitalo-Universitaire TRUE InnovaTive theRapy for immUne disordErs, AP-HP, Henri Mondor Hospital, Créteil, France.
Transpl Int. 2024 Feb 26;37:12065. doi: 10.3389/ti.2024.12065. eCollection 2024.
Late opportunistic infections (OI) occurring beyond the first year after kidney transplantation (KT) are poorly described and not targeted by prophylactic strategies. We performed a ten-year retrospective monocentric cohort study describing epidemiology, risk factors and impact of late OI occurring 1 year after KT. We included clinically symptomatic OI requiring treatment besides BK virus nephropathy. Control groups included early OI occurring in the first year after KT, and KT recipients without OI since KT and alive with a functional allograft at 1 year. Among 1066 KT recipients, 185 (19.4%) presented a first episode of OI 21.0 (8.0-45.0) months after KT: 120 late OI (64.9%) and 65 early OI (35.1%). Late OI were mainly viral ( = 83, 69.2%), mostly herpes zoster (HZ) ( = 36, 43.4%). Pneumocystis represented most late fungal infections ( = 12/25, 48%). Compared to early OI, we reported more pneumocystis ( = 0.002) and less invasive aspergillosis ( = 0.01) among late OI. Patients with late OI were significatively younger at KT (54.0 ± 13.3 vs. 60.2 ± 14.3 years, = 0.05). Patient and allograft survival rates between late OI and control groups were similar. Only age was independently associated with mortality. While late OI were not associated with higher mortality or graft loss, implementing prophylactic strategies might prevent such infections.
肾移植（KT）术后第一年之后发生的晚期机会性感染（OI）鲜有描述，且未被预防性策略所针对。我们进行了一项为期十年的回顾性单中心队列研究，描述KT术后1年发生的晚期OI的流行病学、危险因素及影响。我们纳入了除BK病毒肾病外需要治疗的临床症状性OI。对照组包括KT术后第一年发生的早期OI，以及自KT术后无OI且1年时移植肾功能良好存活的KT受者。在1066例KT受者中，185例（19.4%）在KT术后21.0（8.0 - 45.0）个月出现首次OI发作：120例晚期OI（64.9%）和65例早期OI（35.1%）。晚期OI主要为病毒感染（n = 83，69.2%），大多为带状疱疹（HZ）（n = 36，43.4%）。肺孢子菌是大多数晚期真菌感染的病原体（n = 12/25，48%）。与早期OI相比，晚期OI中肺孢子菌感染更多（P = 0.002），侵袭性曲霉病更少（P = 0.01）。晚期OI患者KT时年龄显著更小（54.0 ± 13.3岁 vs. 60.2 ± 14.3岁，P = 0.05）。晚期OI组与对照组之间的患者及移植肾存活率相似。只有年龄与死亡率独立相关。虽然晚期OI与更高的死亡率或移植肾丢失无关，但实施预防性策略可能预防此类感染。
