Yıldırım Tuba Demirci, Kökoğlu Emel Oğuz, Coşkun Belkıs Nihan, Yıldırım Derya, Basaran Enes, Şenel Abdurrahman Soner, Pehlivan Yavuz, Küçük Hamit, Yazıcı Ayten, Kaşifoğlu Timuçin, Sarı İsmail
Department of Rheumatology, Faculty of Medicine, Dokuz Eylul University, İnciraltı Mahallesi Mithatpaşa Cad. no:1606, Balçova, İzmir, Türkiye.
Department of Rheumatology, Faculty of Medicine, Erciyes University, Kayseri, Türkiye.
Clin Rheumatol. 2025 Feb;44(2):831-838. doi: 10.1007/s10067-024-07287-7. Epub 2024 Dec 24.
To evaluate the incidence and characteristics of severe infections in rheumatic patients receiving biologic disease-modifying anti-rheumatic drugs (bDMARDs) after kidney transplantation.
This multicenter, retrospective study included 38 patients who had undergone kidney transplantation and received bDMARDs for rheumatic diseases. Demographic, clinical, and treatment data were collected. Severe infections were defined as those requiring hospitalization, and the incidence of severe infections was calculated per 100 patient years. Risk factors for severe infections were analyzed.
Of the 38 patients (median age 40.5 years), 52.6% experienced severe infections, with a total of 39 severe infection episodes. The incidence of severe infections was 26.2 per 100 patient-years. The most common infections were urinary tract infections (43.5%) and pneumonia (30.8%). Familial Mediterranean Fever (FMF) was the most common rheumatic disease (57.9%), and the median disease duration was 18.5 years. Most patients (68.4%) were using IL-1 inhibitors, and 31.6% were on anti-TNF therapy. There was no significant difference between patients with and without infections in terms of gender, pre-transplant biological therapy use, or type of biological therapy used. Four patients (11%) died from infection-related complications, including coronavirus disease-19 (COVID-19).
Rheumatic patients receiving bDMARDs post-kidney transplantation have a high risk of severe infections. The concurrent use of immunosuppressive therapy and bDMARDs may further increase this risk, necessitating close infection monitoring and management. Key Points • Rheumatic patients treated with biologic disease-modifying anti-rheumatic drugs (bDMARDs) following kidney transplantation face a heightened risk of severe infections. • The concurrent use of immunosuppressive therapy and bDMARDs may further increase this risk. • Individualized treatment strategies are essential to balance the benefits of bDMARDs with the potential for severe infectious complications.
评估肾移植后接受生物性改善病情抗风湿药物（bDMARDs）治疗的风湿患者中严重感染的发生率及特征。
这项多中心回顾性研究纳入了38例接受肾移植并因风湿性疾病接受bDMARDs治疗的患者。收集了人口统计学、临床和治疗数据。严重感染定义为需要住院治疗的感染，并计算每100患者年的严重感染发生率。分析严重感染的危险因素。
38例患者（中位年龄40.5岁）中，52.6%发生了严重感染，共出现39次严重感染发作。严重感染发生率为每100患者年26.2次。最常见的感染是尿路感染（43.5%）和肺炎（30.8%）。家族性地中海热（FMF）是最常见的风湿性疾病（57.9%），中位病程为18.5年。大多数患者（68.4%）使用白细胞介素-1抑制剂，31.6%接受抗TNF治疗。在性别、移植前生物治疗的使用情况或所使用生物治疗的类型方面，感染患者和未感染患者之间没有显著差异。4例患者（11%）死于感染相关并发症，包括冠状病毒病-19（COVID-19）。
肾移植后接受bDMARDs治疗的风湿患者发生严重感染的风险很高。免疫抑制治疗与bDMARDs的同时使用可能会进一步增加这种风险，因此需要密切监测和管理感染情况。要点•肾移植后接受生物性改善病情抗风湿药物（bDMARDs）治疗的风湿患者面临严重感染风险增加。•免疫抑制治疗与bDMARDs的同时使用可能会进一步增加这种风险。•个体化治疗策略对于平衡bDMARDs的益处与严重感染并发症的可能性至关重要。
