Infections Following Kidney Transplantation After Exposure to Immunosuppression for Treatment of Glomerulonephritis

Abstract

Rationale & ObjectiveKidney transplant patients with glomerulonephritis (GN) as their native disease commonly have received pre-transplant immunosuppression (PTI). This may contribute to the immunosuppression burden potentially increasing the risk for infections following transplantation. Study DesignSingle-center, retrospective cohort study. Setting& Participants: Recipients of a kidney transplant from January 2005 until May 2020 at a tertiary care university teaching hospital. ExposurePatients with GN as their native kidney disease who received PTI for treatment of GN (n=184) were compared to non-diabetic recipients of kidney transplants who did not receive PTI (n=579). OutcomesFirst occurrence after transplantation of an infection outcome, either viral (BK or CMV infection) or bacterial. Analytical ApproachCox regression analysis adjusted for age at transplant, sex, race, donor type, year of transplant surgery, dialysis vintage, receipt of T-cell depleting induction, and CMV transplant status. ResultsOver a median follow-up of 5.7 years, patients with GN PTI were neither at an increased risk for developing any first viral infection compared to controls, aHR (95%CI) 0.69 (0.52-0.91], nor for specific viral infections (BK infection 19.6% vs 26.3%, aHR 0.72 [0.50-1.05]; CMV infection 24.5% vs 29.0%, aHR 0.76 [0.54-1.07], respectively). There was also no increased risk of developing a first bacterial infection (54.5% vs 57.5%, aHR 0.90 [0.71-1.13]). These findings of no increased risk for infection were independent of the type of PTI used (cyclophosphamide, rituximab, mycophenolate mofetil, or calcineurin inhibitor) and the type of T-cell depleting induction therapy (alemtuzumab or anti-thymocyte globulin) administered. LimitationsSingle-center study, no data on methylprednisone use for PTI, unmeasured confounding ConclusionUse of PTI for the treatment of GN was neither associated with an increased risk of viral (BK or CMV) nor of bacterial infection following transplantation. Additional surveillance for infection following transplantation for patients who received PTI may not be necessary.