Opportunistic infections after conversion to belatacept in kidney transplantation

被引：63

作者：

Bertrand, Dominique ^{[1
]}

Chavarot, Nathalie ^{[2
]}

Gatault, Philippe ^{[3
]}

Garrouste, Cyril ^{[4
]}

Bouvier, Nicolas ^{[5
]}

Grall-Jezequel, Anne ^{[6
]}

Jaureguy, Maite ^{[7
]}

Caillard, Sophie ^{[8
]}

Lemoine, Mathilde ^{[9
]}

Colosio, Charlotte ^{[10
]}

Golbin, Leonard ^{[11
]}

Rerolle, Jean-Philippe ^{[12
]}

Thierry, Antoine ^{[13
]}

Sayegh, Johnny ^{[14
]}

Etienne, Isabelle ^{[1
]}

Lebourg, Ludivine ^{[1
]}

Sberro, Rebecca ^{[2
]}

Guerrot, Dominique ^{[1
]}

机构：

[1] Rouen Univ Hosp, Dept Nephrol, Rouen, France

[2] Necker Enfants Malad Univ Hosp, Dept Adult Kidney Transplantat, Paris, France

[3] Tours Univ Hosp, Dept Nephrol, Tours, France

[4] Clermont Ferrand Univ Hosp, Dept Nephrol, Clermont Ferrand, France

[5] Caen Univ Hosp, Dept Nephrol, Caen, France

[6] Brest Univ Hosp, Dept Nephrol, Brest, France

[7] Amiens Univ Hosp, Dept Nephrol, Amiens, France

[8] Strasbourg Univ Hosp, Dept Nephrol, Strasbourg, France

[9] European Georges Pompidou Univ Hosp, Dept Nephrol, Paris, France

[10] Reims Univ Hosp, Dept Nephrol, Reims, France

[11] Rennes Univ Hosp, Dept Nephrol, Rennes, France

[12] Limoges Univ Hosp, Dept Nephrol, Limoges, France

[13] Univ Poitiers Hosp, Dept Nephrol, Poitiers, France

[14] Angers Univ Hosp, Dept Nephrol, Angers, France

来源：

NEPHROLOGY DIALYSIS TRANSPLANTATION | 2020年 / 35卷 / 02期

关键词：

belatacept; infection; kidney transplantation; CALCINEURIN INHIBITOR; SOLID-ORGAN; RESCUE THERAPY; RECIPIENTS; CYTOMEGALOVIRUS; SIROLIMUS; SAFETY; IMMUNOSUPPRESSION; PNEUMONIA; EFFICACY;

D O I：

10.1093/ndt/gfz255

中图分类号：

R3 [基础医学]; R4 [临床医学];

学科分类号：

1001 ; 1002 ; 100602 ;

摘要：

Background Belatacept (bela) rescue therapy seems to be a valuable option for calcineurin inhibitor chronic toxicity in kidney transplantation. Nevertheless, the risk of infection associated with bela is not well reported. Methods We report the rate of opportunistic infections (OPI) after a switch to bela in a multicentric cohort of 280 kidney transplant patients. Results Forty-two OPI occurred in 34 patients (12.1%), on average 10.811.3months after the switch. With a cumulative exposure of 5128months of bela treatment, we found an incidence of 0.008 OPI/month of exposure, and 9.8 OPI/100 person-years. The most common OPI was cytomegalovirus (CMV) disease in 18/42 OPI (42.9%) and pneumocystis pneumonia in 12/42 OPI (28.6%). Two patients presented a progressive multifocal leucoencephalopathy and two patients developed a cerebral Epstein-Barr virus-induced post-transplant lymphoproliferative disease. OPI led to death in 9/34 patients (26.5%) and graft failure in 4/34 patients (11.8%). In multivariate analysis, estimated glomerular filtration rate<25/mL/min/1.73m(2) on the day of the switch and the use of immunosuppressive agents before transplantation were associated with the occurrence of OPI. We found a higher rate of infection-related hospitalization (24.1 versus 12.3/100 person-years, P=0.0007) and also a higher rate of OPI (13.2 versus 6.7/100 person-years, P=0.005) in the early conversion group (within 6months). Conclusions The risk of OPI is significant post-conversion to bela and may require additional monitoring and prophylactic therapy, particularly regarding pneumocystis pneumonia and CMV disease. These data need to be confirmed in a larger case-control study.

引用

页码：336 / 345

页数：10

共 31 条

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