Immunosuppressive therapy management during sepsis in kidney transplant recipients: a prospective multicenter study
A prospective study of 124 kidney transplant recipients admitted to intensive care for sepsis found that stopping mycophenolic acid - but not calcineurin inhibitors - was associated with worse 6-month kidney and survival outcomes.
Study design
A multicenter, prospective, observational study over 1 year in 11 French ICUs enrolling 124 kidney transplant recipients (transplanted at least 3 months earlier) admitted for sepsis. The primary outcome was MAKE-180, a composite of mortality, graft dysfunction, and dialysis requirement at 180 days.
Key findings
Mycophenolic acid was discontinued in 59.7% and calcineurin inhibitors continued in 50.8%. On multivariable analysis, mycophenolic acid discontinuation was significantly associated with MAKE-180 (adjusted OR 1.45, 95% CI 1.07-1.96), while calcineurin inhibitor discontinuation was not (adjusted OR 1.05). Immunosuppression discontinuation was not significantly associated with ICU-acquired infections.
Clinical implications
This first prospective investigation suggests an association between mycophenolic acid discontinuation and adverse outcomes during sepsis in critically ill kidney transplant recipients, but findings must be interpreted cautiously given potential confounding, and interventional trials are needed to optimize immunosuppressive strategy.
Category
Transplant
Source
Annals of Intensive Care
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