In:
PLOS ONE, Public Library of Science (PLoS), Vol. 16, No. 4 ( 2021-4-30), p. e0250829-
Abstract:
Acute antibody-mediated rejection (AMR) remains a challenge after kidney transplantation (KT). As there is no clear-cut treatment recommendation, accurate information on current therapeutic strategies in real-life practice is needed. KT recipients from the multicenter Swiss Transplant Cohort Study treated for acute AMR during the first post-transplant year were included retrospectively. We aimed at describing the anti-rejection protocols used routinely, as well as patient and graft outcomes, with focus on infectious complications. Overall, 65/1669 (3.9%) KT recipients were treated for 75 episodes of acute AMR. In addition to corticosteroid boluses, most common therapies included plasmapheresis (56.0%), intravenous immunoglobulins (IVIg) (38.7%), rituximab (25.3%), and antithymocyte globulin (22.7%). At least one infectious complication occurred within 6 months from AMR treatment in 63.6% of patients. Plasmapheresis increased the risk of overall (hazard ratio [HR]: 2.89; P -value = 0.002) and opportunistic infection (HR: 5.32; P -value = 0.033). IVIg exerted a protective effect for bacterial infection (HR: 0.29; P -value = 0.053). The recovery of renal function was complete at 3 months after AMR treatment in 67% of episodes. One-year death-censored graft survival was 90.9%. Four patients (6.2%) died during the first year (two due to severe infection). In this nationwide cohort we found significant heterogeneity in therapeutic approaches for acute AMR. Infectious complications were common, particularly among KT recipients receiving plasmapheresis.
Type of Medium:
Online Resource
ISSN:
1932-6203
DOI:
10.1371/journal.pone.0250829
DOI:
10.1371/journal.pone.0250829.g001
DOI:
10.1371/journal.pone.0250829.g002
DOI:
10.1371/journal.pone.0250829.g003
DOI:
10.1371/journal.pone.0250829.g004
DOI:
10.1371/journal.pone.0250829.t001
DOI:
10.1371/journal.pone.0250829.t002
DOI:
10.1371/journal.pone.0250829.t003
DOI:
10.1371/journal.pone.0250829.t004
DOI:
10.1371/journal.pone.0250829.t005
DOI:
10.1371/journal.pone.0250829.t006
DOI:
10.1371/journal.pone.0250829.s001
Language:
English
Publisher:
Public Library of Science (PLoS)
Publication Date:
2021
detail.hit.zdb_id:
2267670-3
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