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Schwartz B, Dupont V, Dury S, Carsin-Vu A, Thomas Guillard, Caillard S, Frimat L, Sanchez S, Schvartz B, Bani-Sadr F, Damien Jolly, Philippe Rieu, Antoine Goury. Aetiology, clinical features, diagnostic studies, and outcomes of community-acquired pneumonia in kidney transplant recipients admitted to hospital: a multicentre retrospective French cohort study. Clin Microbiol Infect 2022; 29:542.e1-542.e5. [PMID: 36574948 DOI: 10.1016/j.cmi.2022.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 12/06/2022] [Accepted: 12/18/2022] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To assess the aetiology, clinical features, diagnostic studies and outcomes of community-acquired pneumonia (CAP) in a French cohort of hospitalized kidney transplant recipients. METHODS We performed a retrospective, multicentre study in kidney transplant recipients admitted to ten French centres for CAP from January 2016 to December 2018. CAP discharge diagnoses were clinically and radiologically validated. We assessed a descriptive analysis of all confirmed CAP including medical ward and intensive care unit admissions. RESULTS One hundred sixty-five CAP episodes in 132 patients were included. Median time from transplantation to admission was 6.4 (interquartile range, 1.6-12.3) years, with corticosteroid exposure in 112/165 (67.9%) cases. Sputum culture was performed in 47/165 (28.5%) cases including 7/47 (14.9%) positive samples. Bronchoscopy was performed in 87/165 (52.7%) cases with pathogens identified in 39/87 (44.8%) cases. Microbiological studies led to identifying a respiratory pathogen in 64/165 (38.8%) CAP episodes including 11/64 (17.2%) polymicrobial cases. Among these 64 episodes, 75 microorganisms were identified; 46/75 (61.3%) were core respiratory pathogens and 29/75 (38.7%) were opportunistic or drug-resistant organisms including Pneumocystis jirovecii 9/75 (12%), Pseudomonas aeruginosa 5/75 (6.7%), multidrug-resistant Enterobacteriaceae 4/75 (5.3%), and Aspergillus 4/75 (5.3%). Patients required intensive care unit admission in 26/165 (15.8%) episodes, invasive ventilation in 20/165 (12.1%) cases, and 22/165 (13.3%) needed in-hospital dialysis. DISCUSSION CAP episodes occurred in kidney transplant recipients with a long history of immunosuppressive drug exposure. Diagnostic studies identified a microorganism in more than one-third of CAP episodes, including drug-resistant and opportunistic pathogens.
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Affiliation(s)
- Benoît Schwartz
- Department of Nephrology, Reims University Hospitals, Reims, France
| | - Vincent Dupont
- Department of Nephrology, Reims University Hospitals, Reims, France; French Clinical Research Infrastructure Network, Investigation Network Initiative-Cardiovascular and Renal Clinical Trialists (F-CRIN INI-CRCT), Reims, France; Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Sandra Dury
- Department of Respiratory Diseases, Reims University Hospitals, Reims, France; EA7509 IRMAIC, University of Reims Champagne-Ardenne, Reims, France
| | - Aline Carsin-Vu
- Department of Radiology, Reims University Hospitals, Reims, France
| | - Thomas Guillard
- Université de Reims Champagne-Ardenne, INSERM, CHU de Reims, Laboratoire de Bactériologie-Virologie-Hygiène Hospitalière-Parasitologie-Mycologie, P3Cell, Reims, France; Laboratoire de Bactériologie-Virologie-Hygiène Hospitalière-Parasitologie-Mycologie, Reims University Hospitals, Hôpital Robert Debré, Reims, France
| | - Sophie Caillard
- Department of Nephrology and Transplantation, Strasbourg University Hospitals, Strasbourg, France; INSERM 1109, Fédération de Médecine Translationnelle, LabEx TRANSPLANTEX, Strasbourg, France
| | - Luc Frimat
- Department of Nephrology and Transplantation, Nancy University Hospitals, Vandoeuvre les Nancy, France; EA 4360, INSERM CIC-EC CIE6, Apemac, Vandoeuvre les N, France
| | - Stephane Sanchez
- Clinical Research and Methological Unit, Troyes Hospital, Troyes, France
| | - Betoul Schvartz
- Department of Nephrology, Reims University Hospitals, Reims, France
| | - Firouzé Bani-Sadr
- Department of Internal Medicine, Infectious Diseases, and Clinical Immunology, Reims University Hospitals, Reims, France
| | - Damien Jolly
- Department of Research and Public Health, Reims University Hospitals, Reims, France
| | - Philippe Rieu
- Department of Nephrology, Reims University Hospitals, Reims, France
| | - Antoine Goury
- Intensive Care Department, Reims University Hospitals, Reims, France.
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Pathak V, Madhavan D, Narayanasamy K, Kumar S, Ramalingam V, Sengodagounder B, Bodonyi-Kovacs G. Low-dose Rituximab and Thymoglobulin Induction With Steroid-free Maintenance Immunosuppression and Protocol Biopsies Improves Long-term Patient and Graft Survival After Kidney Transplantation: Survival and Safety Outcomes in More Than 1100 Patients From a Single Center. Transplant Direct 2019; 5:e475. [PMID: 31576371 PMCID: PMC6708634 DOI: 10.1097/txd.0000000000000923] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 06/04/2019] [Accepted: 06/11/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Steroid-free maintenance immunosuppression after kidney transplantation provides acceptable patient and graft survival and minimizes steroid-associated side effects among recipients with a low immunological risk. However, the long-term outcomes of such protocols, incorporating low-dose rituximab and thymoglobulin induction along with protocol biopsies, in non-European populations remains underreported. METHODS We retrospectively analyzed 1142 consecutive kidney transplantations conducted at our center from July 2005 to October 2017. Immunosuppression protocol included induction with thymoglobulin and low-dose preoperative rituximab. Maintenance immunosuppression consisted of tacrolimus and mycophenolate mofetil; prednisolone was discontinued on postoperative day 5. Protocol biopsies were carried out at 3 months and at 1, 5, and 10 years after transplantation-in addition to the indicated biopsies. The 12-year patient and graft survival and posttransplantation complications were studied. RESULTS The analysis of outcomes was conducted for 1111 transplant recipients. Patients (70.59%) remained steroid-free at 12 years after transplantation. The patient survival rates at 1, 5, and 12 years were 97.7%, 94.8%, and 92.4%, respectively. The corresponding graft survival rates were 97.2%, 90.9%, and 86.1%, respectively. Biopsy-proven acute rejection occurred in 12.7% of recipients, including 3.5% subclinical rejections. The cumulative incidence of graft loss was 6.56% at 12.3 years. The overall incidence of death was 5.3%. CONCLUSIONS Steroid-free maintenance immunosuppression was associated with excellent long-term patient and graft survival rates and reduced incidence of prednisolone-related side effects, despite acceptable rejection rates. Low-dose rituximab with thymoglobulin induction with immediate steroid withdrawal and surveillance biopsies resulted in excellent long-term outcomes in our single-center experience.
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Affiliation(s)
- Vivek Pathak
- Consultant Nephrologist, Kovai Medical Center, Coimbatore, India
| | - Devdas Madhavan
- Consultant Urologist, Kovai Medical Center, Coimbatore, India
| | | | - Sampath Kumar
- Consultant Urologist, Kovai Medical Center, Coimbatore, India
| | | | | | - Gabor Bodonyi-Kovacs
- Assistant Professor, Division of Nephrology, MFA, George Washington University, Washington, DC
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