Management of immunosuppressive therapy in liver transplant recipients who develop bloodstream infection

Bartoletti, Michele; Vandi, Giacomo; Furii, Francesca; Bertuzzo, Valentina Rosa; Ambretti, Simone; Tedeschi, Sara; Pascale, Renato; Cristini, Francesco; Campoli, Caterina; Morelli, Cristina; Cescon, Matteo; Pinna, Antonio Daniele; Viale, Pierluigi; Giannella, Maddalena

doi:10.1111/tid.12930

Cited by 13 publications

(10 citation statements)

References 26 publications

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“…Despite surgical developments in the field of transplantation, infectious complications remain a major cause of morbidity and mortality for pediatric patients after transplantation. Studies have showed that transplant patients who develop systemic infections could have a worse prognosis (25)(26)(27). In our study, it has been noted that infection rate reached 74.1%, and infection cases took up the majority of adverse events.…”

Section: Discussionsupporting

confidence: 49%

Immune cell function assays in the diagnosis of infection in pediatric liver transplantation: an open-labeled, two center prospective cohort study

et al. 2021

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Background: Limited studies have been performed in assessment of immune status of pediatric liver transplants (PLTs). We conducted this study to evaluate Cylex immune cell function assay in diagnosis of infection and its potential clinical application in Chinese infant PLTs. Methods:In this prospective cohort study, 227 infant PLTs from two medical centers were enrolled, and 216 completed the study. Cylex ATP values were measured before and after liver transplantation (LT) at week 1, 2, 3, 4, 8, 12 and 24 respectively. Accordingly, patients' clinical records, including demographic data, liver function results, tacrolimus dosages and concentrations were collected and analyzed.Results: One hundred and sixty of 216 PLTs (74.1%) were diagnosed infection based on the parameters including abnormal vital signs, imaging changes, and pathogens detection, while 44 (20.4%) were clinically stable and 12 (5.6%) experienced acute rejection. The median Cylex ATP value in infant PLTs post-surgery reduced significantly in infection group compared to stable group (median, 137 vs. 269 ng/mL, P<0.001).Receiver operating characteristic (ROC) curve analysis determined that the cut-off value of Cylex ATP was 152 ng/mL in diagnosis of infection [area under the curve (AUC): 0.784, 95% CI: 0.720-0.848]. Meanwhile, Cylex ATP value showed no correlation to tacrolimus dosage, blood concentration, dose-normalized concentration/dose ratio or Kaup index. However, it tended to correlate weakly with the white blood cell (WBC) number (R =0.462, P<0.0001) and lymphocyte counts (R =0.363, P<0.0001). Conclusions:In this study, we demonstrated that low Cylex ATP represented partly overimmunosuppression and had diagnostic value in infant PLTs with infections, which might assist individualized immunosuppression in PLT patients.

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Section: Discussionsupporting

confidence: 49%

Immune cell function assays in the diagnosis of infection in pediatric liver transplantation: an open-labeled, two center prospective cohort study

et al. 2021

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“…Nevertheless, some experts believe that a reduction in immunosuppression may lead to higher mortality by increasing the capacity of the immune system to induce a systemic inflammatory response. 26 CMV is an immunomodulatory virus that cans favor bacterial infections. 27 Theoretically, CMV prevention could reduce this increased risk, 28 although recent consensus does not recommend CMV prophylaxis in the scenario of solid organ transplantation.…”

Section: Discussionmentioning

confidence: 99%

Predictors of mortality in solid organ transplant recipients with bloodstream infections due to carbapenemase-producing Enterobacterales: The impact of cytomegalovirus disease and lymphopenia

Pérez‐Nadales

Gutiérrez‐Gutiérrez

Natera

et al. 2020

American Journal of Transplantation

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“…A recent retrospective study including 157 liver transplanted patients documented immunosuppression reduction during bloodstream infection to be associated with worse outcomes. Specifically, reduction or discontinuation of at least one immunosuppressive drug was a significant risk factor for 28 days mortality …”

Section: Discussionmentioning

confidence: 99%

Immunosuppression reduction in kidney transplant recipients during bacterial infection—A retrospective study

Yahav

Sulimani

Green

et al. 2019

Clinical Transplantation

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Background: Immunosuppression reduction is a common practice in the management of bacterial infection among kidney transplant recipients (KTRs). This practice, however, is based on limited evidence. Methods:Retrospective study comparing clinical outcomes of KTRs whose antimetabolite was discontinued vs continued during hospitalization due to bacterial infection, considering calcineurin inhibitors (CNI) levels. Primary outcome was a composite of clinical failure at day 5; all-cause mortality; and/or re-hospitalization at 90 days.Multivariable analysis of risk factors for the primary outcome was performed using a propensity-matched cohort. Results:We included 183 KTRs hospitalized with bacterial infection. Neither discontinuation of antimetabolites nor lower levels of CNI at infection onset were associated with a significant decrease the composite primary outcome. No significant difference in graft loss or rejection was demonstrated between patients with low vs high CNI levels or discontinuation vs continuation of antimetabolite. In multivariable analysis, CNI levels and management of antimetabolite were not significantly associated with adverse outcome.Conclusions: Immunosuppression reduction in hospitalized KTRs with bacterial infection did not offer a clinical advantage in terms of mortality, re-hospitalization, or clinical success. An interventional study evaluating continuation of immunosuppression vs reduction should be considered.

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Management of immunosuppressive therapy in liver transplant recipients who develop bloodstream infection

Abstract: Any reduction in the immunosuppressive therapy was common and was associated with worse outcome in LT recipients developing BSI.

Cited by 13 publications

References 26 publications

Immune cell function assays in the diagnosis of infection in pediatric liver transplantation: an open-labeled, two center prospective cohort study

Immune cell function assays in the diagnosis of infection in pediatric liver transplantation: an open-labeled, two center prospective cohort study

Predictors of mortality in solid organ transplant recipients with bloodstream infections due to carbapenemase-producing Enterobacterales: The impact of cytomegalovirus disease and lymphopenia

Immunosuppression reduction in kidney transplant recipients during bacterial infection—A retrospective study

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