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Quantifying infection risks in incompatible living donor kidney transplant recipients
Robin K Avery1, Jennifer D Motter2, Kyle R Jackson2
1Division of Infectious Disease, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Summary
Incompatible living donor kidney transplantation (ILDKT) recipients undergoing desensitization face increased infection risks, particularly those with high-intensity protocols. Strategies are needed to mitigate infection-related complications and optimize ILDKT benefits.
Area of Science:
- Nephrology
- Immunology
- Transplantation Medicine
Background:
- Desensitization protocols enable kidney transplantation across HLA/ABO barriers.
- Increased immunomodulation during desensitization may elevate infection risks in patients.
Purpose of the Study:
- To evaluate the association between desensitization intensity and post-kidney transplant infection rates.
- To identify patient subsets at higher risk for infections and adverse outcomes after ILDKT.
Main Methods:
- Retrospective study of 475 kidney transplant recipients from 2010-2015.
- Categorization of recipients based on desensitization intensity: none/compatible, low, moderate, and high.
- Analysis of 1-year cumulative infection incidence, infection types, and association with outcomes like hospitalization and graft loss.
Main Results:
- The 1-year infection incidence was 50.1% (none), 49.8% (low), 66.0% (moderate), and 73.5% (high).
- Urinary tract, opportunistic, and bloodstream infections were most common.
- High-intensity desensitization significantly increased infection risk (2.22-fold), with ≥4 infections linked to prolonged hospitalization and graft loss.
Conclusions:
- Post-transplant infections are more prevalent in desensitized ILDKT recipients.
- Highly desensitized patients represent an ultra-high-risk group for infections.
- Developing strategies to prevent recurrent infections is crucial for improving ILDKT outcomes.
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