Vnučák Matej, Graňák Karol, Beliančinová Monika, Kleinová Patrícia, Blichová Tímea, Doboš Vladimír, Dedinská Ivana
Transplant-Nephrology Centre, University Hospital Martin, Kollárova 2, 03601 Martin, Slovakia.
1st Department of Internal Diseases, University Hospital Martin and Jessenius Medical Faculty of Comenius University, Kollárova 2, 03601 Martin, Slovakia.
J Clin Med. 2024 Apr 9;13(8):2162. doi: 10.3390/jcm13082162.
Potent immunosuppression lowers the incidence of acute graft rejection but increases the risk of infections. In order to decrease either infectious complications or acute rejection, it is necessary to identify risk groups of patients profiting from personalized induction immunosuppressive treatment. The aim of our analysis was to find whether there were higher incidences of infectious complications after kidney transplantation (KT) in groups with different induction immunosuppressive treatment and also to find independent risk factors for recurrent infections. We retrospectively evaluated all patients with induction treatment with basiliximab after kidney transplantation from 2014 to 2019 at our center relative to age- and sex-matched controls of patients with thymoglobulin induction immunosuppression. : Our study consisted of two groups: basiliximab (39) and thymoglobulin (39). In the thymoglobulin group we observed an increased incidence of recurrent infection in every observed interval; however, acute rejection was seen more often in the basiliximab group. A history of respiratory diseases and thrombocytopenia were identified as independent risk factors for recurrent bacterial infections from the first to sixth month after KT. Decreased eGFR from the first month, infections caused by multi-drug-resistant bacteria, and severe infections (reflected by the need for hospitalization) were identified as independent risk factors for recurrent bacterial infections from the first to the twelfth month after KT. : We found that in the group of patients with thymoglobulin induction immunosuppressive treatment, infectious complications occurred significantly more often during the entire monitored period with decreased incidence of acute humoral and cellular rejection occurred more often.
强效免疫抑制可降低急性移植物排斥反应的发生率，但会增加感染风险。为了减少感染并发症或急性排斥反应，有必要识别能从个性化诱导免疫抑制治疗中获益的患者风险群体。我们分析的目的是确定在接受不同诱导免疫抑制治疗的肾移植（KT）患者组中，感染并发症的发生率是否更高，并找出反复感染的独立危险因素。我们回顾性评估了2014年至2019年在我们中心接受巴利昔单抗诱导治疗的所有肾移植患者，并与接受胸腺球蛋白诱导免疫抑制治疗的年龄和性别匹配的患者对照组进行比较。我们的研究包括两组：巴利昔单抗组（39例）和胸腺球蛋白组（39例）。在胸腺球蛋白组中，我们观察到在每个观察期反复感染的发生率都有所增加；然而，急性排斥反应在巴利昔单抗组中更为常见。呼吸道疾病史和血小板减少被确定为肾移植后第一个月至第六个月反复细菌感染的独立危险因素。移植后第一个月估算肾小球滤过率（eGFR）下降、多重耐药菌引起的感染以及严重感染（以住院需求为指标）被确定为肾移植后第一个月至第十二个月反复细菌感染的独立危险因素。我们发现，在接受胸腺球蛋白诱导免疫抑制治疗的患者组中，在整个监测期感染并发症明显更常发生，而急性体液和细胞排斥反应的发生率则较低。
