Postrenal transplant infection: What is the effect of specific immunosuppressant agents?

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Background:Immunosuppression is a known risk for post-transplant infections. Little data exist on the risk contributions of specific agents for various infections.Methods:A triply robust propensity score–adjusted analysis was performed in a renal transplant cohort between February 2006 and January 2014. The study was performed to identify the incidence and the risk factors for developing a post-transplant infection. After initial bivariate analysis, a triply robust propensity score–adjusted multivariate logistic regression was performed.Results:The mean age of the 717 renal transplant recipients was 50.0 ± 13.3 years, with the majority being male (61.6%) and 349 (48.7%) experiencing at least 1 post-transplant infection. Neither race, graft type, nor insurance status was associated with an increased incidence or risk of infection. In a fully adjusted regression model, the immunosuppressants mycophenolic acid mofetil (OR 0.38, 95% CI 0.21–0.71; P < .001) and alemtuzumab (OR 0.40, 95% CI 0.19–0.85; P=.020) were protective.Conclusion:Alemtuzumab and mycophenolic acid mofetil as immunosuppressant agents in a multiagent protocol appear to decrease the incidence of infection. Cytomegalovirus antigenemia was the greatest risk for infection and mycophenolic acid mofetil possessed the greatest protective effect on viral infections.

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