Evolving trends in immunosuppression use and cytomegalovirus infection risk over the past decade in kidney transplantation.

IF 2.6 4区医学 Q3 IMMUNOLOGY Transplant Infectious Disease Pub Date : 2024-10-01 Epub Date: 2024-06-30 DOI:10.1111/tid.14318

Karim Soliman, Isabel K Calimlim, Amy Perry, Erika Andrade, Morgan Overstreet, Neha Patel, Felicia Bartlett, David J Taber

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Abstract

Background: The goal was to determine trends in immunosuppression use and its impact on cytomegalovirus (CMV) outcomes over the past 10 years.

Methods: This was a single-center longitudinal cohort study of adult kidney recipients transplanted between Jan 2012 and June 2021. Baseline and follow-up data were gathered via chart abstraction and analyzed using univariate and multivariate analyses.

Results: Of 2392 kidney transplants conducted, 131 patients did not meet inclusion criteria. The mean age was 52 years, 41% were female, 57% were black, and 19% were CMV high-risk. The use of rabbit anti-thymocyte globulin (RATG) induction (odds ratio [OR] 1.6, 1.3-2.1), tacrolimus (FK) level >8 ng/mL (OR 1.1, 1.09-1.11), CMV D+/R- rates (OR 1.06, 1.02-1.10), white blood cell count <3000 (OR 1.22, 1.18-1.26) and valganciclovir prophylaxis (OR 1.7, 1.6-1.9) have significantly increased over the past 10 years. Rejection rates (OR 0.86, 0.82-0.91) and BK viremia >2000 (OR 0.91, 0.91-0.98) have decreased. RATG induction (adjusted hazard ratio [aHR] 1.35, 1.2-1.5), FK >8 ng/mL (aHR 3.5, 3.2-3.9), Belatacept conversion (aHR 2.5, 2.1-3.1), and rejection (aHR 1.8, 1.6-2.0) were significant risk factors for developing CMV infection, while mycophenolate mofetil <1500 mg (aHR 0.52, 0.47-0.59), mammalian target of rapamycin inhibitor (mTORi) conversion (0.77, 0.56-0.89), cyclosporine-A conversion (aHR 0.68, 0.56-0.84) were associated with lower risk of CMV infection.

Conclusion: Increasing use of potent immunosuppression coupled with higher CMV D+/R- F rates may be driving higher rates of CMV infection. Cyclosporine and mTORi conversion appears to be protective against CMV. A more individualized immunosuppression regimen based on infection risk merits consideration.

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过去十年肾移植中使用免疫抑制剂和巨细胞病毒感染风险的演变趋势。

背景：目的是确定过去 10 年中使用免疫抑制剂的趋势及其对巨细胞病毒（CMV）结果的影响：目的是确定过去 10 年中免疫抑制的使用趋势及其对巨细胞病毒（CMV）预后的影响：这是一项单中心纵向队列研究，研究对象为 2012 年 1 月至 2021 年 6 月间接受移植的成年肾脏受者。通过病历摘要收集基线和随访数据，并采用单变量和多变量分析方法进行分析：在进行的 2392 例肾移植中，有 131 例患者不符合纳入标准。平均年龄为 52 岁，41% 为女性，57% 为黑人，19% 为 CMV 高危人群。使用兔抗胸腺细胞球蛋白（RATG）诱导（几率比 [OR] 1.6，1.3-2.1）、他克莫司（FK）水平>8 ng/mL（OR 1.1，1.09-1.11）、CMV D+/R-率（OR 1.06，1.02-1.10）、白细胞计数 2000（OR 0.91，0.91-0.98）均有所下降。RATG诱导（调整后危险比[aHR] 1.35，1.2-1.5）、FK >8 ng/mL（aHR 3.5，3.2-3.9）、Belatacept转换（aHR 2.5，2.1-3.1）和排斥反应（aHR 1.8，1.6-2.0）是发生CMV感染的重要危险因素，而霉酚酸酯（mycophenolate mofetil）和RATG诱导（调整后危险比[aHR] 1.35，1.2-1.5）是发生CMV感染的重要危险因素：越来越多地使用强效免疫抑制剂以及较高的CMV D+/R- F率可能会导致CMV感染率升高。环孢素和 mTORi 转换似乎对 CMV 有保护作用。根据感染风险制定更加个性化的免疫抑制方案值得考虑。

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来源期刊

Transplant Infectious Disease 医学-传染病学

CiteScore

5.30

自引率

7.70%

发文量

210

审稿时长

4-8 weeks

期刊介绍： Transplant Infectious Disease has been established as a forum for presenting the most current information on the prevention and treatment of infection complicating organ and bone marrow transplantation. The point of view of the journal is that infection and allograft rejection (or graft-versus-host disease) are closely intertwined, and that advances in one area will have immediate consequences on the other. The interaction of the transplant recipient with potential microbial invaders, the impact of immunosuppressive strategies on this interaction, and the effects of cytokines, growth factors, and chemokines liberated during the course of infections, rejection, or graft-versus-host disease are central to the interests and mission of this journal. Transplant Infectious Disease is aimed at disseminating the latest information relevant to the infectious disease complications of transplantation to clinicians and scientists involved in bone marrow, kidney, liver, heart, lung, intestinal, and pancreatic transplantation. The infectious disease consequences and concerns regarding innovative transplant strategies, from novel immunosuppressive agents to xenotransplantation, are very much a concern of this journal. In addition, this journal feels a particular responsibility to inform primary care practitioners in the community, who increasingly are sharing the responsibility for the care of these patients, of the special considerations regarding the prevention and treatment of infection in transplant recipients. As exemplified by the international editorial board, articles are sought throughout the world that address both general issues and those of a more restricted geographic import.