Infectious complications in living-donor kidney transplant recipients undergoing multi-modal desensitization.
Infectious complications in living-donor kidney transplant recipients undergoing multi-modal desensitization.
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接受多模式脱敏的活体肾移植受者的感染并发症。
DOI：
10.1089/sur.2012.231
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发表时间：
2014
影响因子：
2
通讯作者：
Agarwal,Avinash
中科院分区：
文献类型：
--
作者：
Turza,KristinC;Shafique,Michael;Lobo,PeterI;Sawyer,RobertG;Keith,DouglasS;Brayman,KennethL;Agarwal,Avinash
背景：预先存在的体液屏障挑战活体供肾（LDK）移植到高度致敏的ABO和人类白细胞抗原（HLA）不相容的受者。这些LDK受体在接受移植前需要调节免疫系统。我们假设，医学脱敏将产生更高的移植后感染率。方法：我们进行了一项研究，其中匹配的控制组成的非脱敏（NDS）LDK收件人进行了比较与脱敏（DS）recipients。移植前脱敏包括利妥昔单抗和霉酚酸酯治疗，然后静脉注射免疫球蛋白（IVIg）和血浆置换。所有参与者都接受了诱导治疗和维持免疫抑制。主要结果包括感染（机会性，局部，全身）在12个月内transplantation.Results：25例患者进行脱敏和LDK移植。DS组和NDS组患者的移植物存活率分别为96%和98%。DS组和NDS组的平均3个月和12个月血清肌酐浓度分别为1.1±0.2 mg/dL和1.2±0.3 mg/dL以及0.95± 0.4 mg/dL和0.73± 0.8 mg/dL（p=0.3和p=0.01）。DS组36%的患者有一次或多次感染，NDS组为28%（p=0.1）。两组机会性或全身性感染的发生率无差异。局部感染在统计学上更频繁的DS组（60%对30%，分别为; p=0.02）。结论：术前脱敏在高致敏LDK受体其次是一个类似的机会性和全身感染的发生率在NDS患者。在研究中，DS患者的局部感染频率明显高于NDS患者。通过对感染并发症的仔细监测，移植前脱敏允许LDK移植到高度致敏的患者中。
Background:Pre-existing humoral barriers challenge the transplantation of living donor kidneys (LDK) into highly sensitized ABO- and human leukocyte antigen (HLA)-incompatible recipients. Conditioning these LDK recipients' immune systems is required before they undergo transplantation. We hypothesized that medical desensitization would yield higher post-transplantation rates of infection.Methods:We conducted a study in which matched controls consisting of non-desensitized (NDS) LDK recipients were compared with desensitized (DS) receipients. Pre-transplantation desensitization included treatment with rituximab and mycophenolate mofetil followed by intravenous immunoglobulin (IVIg) and plasmapheresis. All participants in the study underwent induction therapy and maintenance immunosuppression. Primary outcomes included infection (opportunistic, local, systemic) within 12 mo after transplantation.Results:Twenty-five patients underwent desensitization and LDK transplantation. Graft survival in the DS and NDS groups of patients was 96% and 98%, respectively. The mean 3- and 12-mo serum creatinine concentrations in the DS and NDS groups were 1.1±0.2 mg/dL and 1.2±0.3 mg/dL and 0.95±0.4mg/dL and 0.73±0.8mg/dL (p=0.3 and p=0.01), respectively. Thirty-six percent of the patients in the DS group had one or more infections, vs. 28% of those in the NDS group (p=0.1). No difference was observed in the frequency of opportunistic or systemic infections in the two groups. Local infections were statistically significantly more frequent in the DS group (60% vs. 30%, respectively; p=0.02).Conclusion:Pre-operative desensitization in highly sensitized LDK recipients is followed by a similar incidence of opportunistic and systemic infections as in NDS patients. Local infections were significantly more frequent in the DS than in the NDS patients in the study. With careful monitoring of infectious complications, pre-transplant desensitization permits LDK transplantation into highly sensitized patients.