Dafna Yahav1,2, Omri Sulimani3, Hefziba Green2,4,5, Ili Margalit2,6, Haim Ben-Zvi2,7, Eytan Mor2,8, Benaya Rozen-Zvi2,4. 1. Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel. 2. Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel. 3. Department of general surgery, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel. 4. Department of Nephrology and Hypertension, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel. 5. Medicine B, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel. 6. Medicine F, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel. 7. Microbiology Laboratory, Rabin Medical Center, Beilinson Hospital, Petach-Tikva, Israel. 8. Department of Transplantation, Rabin Medical Center, Petah-Tikva, Israel.
Abstract
BACKGROUND: Immunosuppression reduction is a common practice in the management of bacterial infection among kidney transplant recipients (KTRs). This practice, however, is based on limited evidence. METHODS: Retrospective study comparing clinical outcomes of KTRs whose antimetabolite was discontinued vs continued during hospitalization due to bacterial infection, considering calcineurin inhibitors (CNI) levels. Primary outcome was a composite of clinical failure at day 5; all-cause mortality; and/or re-hospitalization at 90 days. Multivariable analysis of risk factors for the primary outcome was performed using a propensity-matched cohort. RESULTS: We included 183 KTRs hospitalized with bacterial infection. Neither discontinuation of antimetabolites nor lower levels of CNI at infection onset were associated with a significant decrease the composite primary outcome. No significant difference in graft loss or rejection was demonstrated between patients with low vs high CNI levels or discontinuation vs continuation of antimetabolite. In multivariable analysis, CNI levels and management of antimetabolite were not significantly associated with adverse outcome. CONCLUSIONS: Immunosuppression reduction in hospitalized KTRs with bacterial infection did not offer a clinical advantage in terms of mortality, re-hospitalization, or clinical success. An interventional study evaluating continuation of immunosuppression vs reduction should be considered.
BACKGROUND: Immunosuppression reduction is a common practice in the management of bacterial infection among kidney transplant recipients (KTRs). This practice, however, is based on limited evidence. METHODS: Retrospective study comparing clinical outcomes of KTRs whose antimetabolite was discontinued vs continued during hospitalization due to bacterial infection, considering calcineurin inhibitors (CNI) levels. Primary outcome was a composite of clinical failure at day 5; all-cause mortality; and/or re-hospitalization at 90 days. Multivariable analysis of risk factors for the primary outcome was performed using a propensity-matched cohort. RESULTS: We included 183 KTRs hospitalized with bacterial infection. Neither discontinuation of antimetabolites nor lower levels of CNI at infection onset were associated with a significant decrease the composite primary outcome. No significant difference in graft loss or rejection was demonstrated between patients with low vs high CNI levels or discontinuation vs continuation of antimetabolite. In multivariable analysis, CNI levels and management of antimetabolite were not significantly associated with adverse outcome. CONCLUSIONS: Immunosuppression reduction in hospitalized KTRs with bacterial infection did not offer a clinical advantage in terms of mortality, re-hospitalization, or clinical success. An interventional study evaluating continuation of immunosuppression vs reduction should be considered.