Immunosuppressive therapy and infection after kidney transplantation

Background: The role of immunosuppressive drugs in the development of infection in transplant recipients has been poorly analyzed.

Objective: To evaluate the possible association between infection and immunosuppression regimens in a large cohort of renal transplant recipients.

Methods: All renal transplant recipients included in the RESITRA prospective cohort from August 2003 to February 2005 with a minimum follow-up of 3 months were studied. An intention-to-treat analysis was performed and patients were analyzed in groups according to the type of induction and initial maintenance therapy. Viral, bacterial, and fungal infections occurring during this period were evaluated.

Results: A total of 1398 renal transplant recipients were studied. A maintenance regimen containing sirolimus was independently associated with a lower risk of cytomegalovirus (CMV) infection (odds ratio [OR], 0.16; 95% confidence interval [CI], 0.05-0.54) and with a higher rate of surgical site infection (OR, 3.21; 95% CI, 1.26-8.21). Excluding treatment used for acute rejection episodes, no other factors related to the immunosuppression regimens were associated with the development of bacteremia, urinary infections, pneumonia, or other infections.

Conclusion: The use of sirolimus as maintenance therapy in kidney recipients is associated with a low rate of CMV infection and with a higher risk of surgical site infection.