Format

Send to

Choose Destination
Transpl Infect Dis. 2019 Oct;21(5):e13134. doi: 10.1111/tid.13134. Epub 2019 Jul 12.

Immunosuppression reduction in liver and kidney transplant recipients with suspected bacterial infection: A multinational survey.

Author information

1
Medicine A, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.
2
Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel.
3
Department of Diagnostic Imaging, Chaim Sheba Medical Center, Ramat Gan, Israel.
4
Department of Nephrology and Hypertension, Rabin Medical Center, Petah Tikva, Israel.
5
Medicine B, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.
6
Rabin Medical Center, The Liver Institute, Petah-Tikva, Israel.
7
Division of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
8
Department of Microbiology and Division of Infectious Diseases, CUB-Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium.
9
Department of Cardiology, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.
10
Transplantation Center and Infectious Diseases Service, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland.
11
Department of Transplantation, Rabin Medical Center, Petah Tikva, Israel.
12
Clinical Unit of Infectious Diseases, University Hospital 'Reina Sofía', Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), School of Medicine, University of Córdoba, Córdoba, Spain.
13
Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.

Abstract

BACKGROUND:

There is no consensus on the optimal management of immunosuppression during bacterial infections among solid organ transplant recipients.

METHODS:

A multicenter, cross-sectional survey, of high-volume kidney and liver transplant centers across US and Europe. Structured questionnaires including six multiple-choice questions concerning the management of immunosuppression during infection were distributed among 381 centers.

RESULTS:

A total of 124 (33%) centers fully completed the questionnaire: 67 liver, 57 kidney centers. Participating centers reported heterogenous approaches to immunosuppression management for all types of immunosuppressive drugs. Notably, kidney centers reported similar frequencies of either discontinuation (19%), continuation (19%), or dose reduction (17.5%) of antimetabolites; discontinuation only for life-threatening infection (17.5%) or case by case decisions (27%). Calcineurin inhibitors (CNI) management was heterogenous mostly among liver centers, with 8% discontinuing the CNI, 18% continuing, and 22% reducing dose. Heterogenous approaches to management of steroids and inhibitors of the mammalian target of rapamycin were also demonstrated.

CONCLUSIONS:

Immunosuppression management during bacterial infection is heterogenous in US and European centers. Immunosupression reduction (ISR) during infection is a common practice, though supported by limited evidence. Demonstrating high heterogeneity in the approach to ISR, together with the equivocal results of clinical studies, support consideration of an interventional clinical trial.

KEYWORDS:

immunosuppression reduction; infection; kidney transplant; liver transplant

PMID:
31242341
DOI:
10.1111/tid.13134

Supplemental Content

Full text links

Icon for Wiley
Loading ...
Support Center