PMID- 24773230
OWN - NLM
STAT- MEDLINE
DCOM- 20150204
LR  - 20211021
IS  - 1557-8674 (Electronic)
IS  - 1096-2964 (Print)
IS  - 1096-2964 (Linking)
VI  - 15
IP  - 3
DP  - 2014 Jun
TI  - Infectious complications in living-donor kidney transplant recipients undergoing 
      multi-modal desensitization.
PG  - 182-6
LID - 10.1089/sur.2012.231 [doi]
AB  - 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+/-0.4 mg/dL and 0.73+/-0.8 mg/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.
FAU - Turza, Kristin C
AU  - Turza KC
AD  - 1 Department of Surgery, University of Virginia , Charlottesville, Virginia.
FAU - Shafique, Michael
AU  - Shafique M
FAU - Lobo, Peter I
AU  - Lobo PI
FAU - Sawyer, Robert G
AU  - Sawyer RG
FAU - Keith, Douglas S
AU  - Keith DS
FAU - Brayman, Kenneth L
AU  - Brayman KL
FAU - Agarwal, Avinash
AU  - Agarwal A
LA  - eng
GR  - T32 AI078875/AI/NIAID NIH HHS/United States
PT  - Journal Article
DEP - 20140428
PL  - United States
TA  - Surg Infect (Larchmt)
JT  - Surgical infections
JID - 9815642
SB  - IM
MH  - Adult
MH  - Aged
MH  - Case-Control Studies
MH  - Desensitization, Immunologic/*adverse effects/methods
MH  - Female
MH  - Humans
MH  - Incidence
MH  - Kidney Transplantation/*adverse effects
MH  - *Living Donors
MH  - Male
MH  - Middle Aged
MH  - Opportunistic Infections/*epidemiology
MH  - Preoperative Care/*adverse effects/methods
MH  - Retrospective Studies
MH  - *Transplant Recipients
PMC - PMC4696441
EDAT- 2014/04/30 06:00
MHDA- 2015/02/05 06:00
PMCR- 2015/06/01
CRDT- 2014/04/30 06:00
PHST- 2014/04/30 06:00 [entrez]
PHST- 2014/04/30 06:00 [pubmed]
PHST- 2015/02/05 06:00 [medline]
PHST- 2015/06/01 00:00 [pmc-release]
AID - 10.1089/sur.2012.231 [pii]
AID - 10.1089/sur.2012.231 [doi]
PST - ppublish
SO  - Surg Infect (Larchmt). 2014 Jun;15(3):182-6. doi: 10.1089/sur.2012.231. Epub 2014 
      Apr 28.