Abstract: SA-PO1121
Incidence of and Risk Factors for Infectious Complications After Intensified Immunosuppressive Therapy for Kidney Allograft Rejection at a Tertiary Referral Center in Mexico City
Session Information
- Transplantation: Clinical - Infectious Diseases
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2002 Transplantation: Clinical
Authors
- Santander, Jesus Ivan, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, CDMX, Mexico
- Morales Buenrostro, Luis Eduardo, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, CDMX, Mexico
Group or Team Name
- Department of Nephrology and Mineral Metabolism
Background
Treatment of kidney allograft rejection often requires intensified immunosuppression, which increases the risk of opportunistic and bacterial infections. Data from Latin America are limited, where Tuberculosis endemicity and resource-constrained monitoring may influence infection patterns.
Methods
We conducted a retrospective cohort study of adult kidney transplant recipients treated for biopsy-proven rejection at the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán from 2022 to 2025. Borderline, T Cell–Mediated Rejection, Antibody-Mediated Rejection, and mixed rejection were included. The first rejection episode served as the index event, and prior rejection episodes were recorded. Treatment intensity was classified as mild (corticosteroids alone), moderate (corticosteroids plus one additional therapy), and high (corticosteroids, plasma exchange, Intravenous Immunoglobulin, and Rituximab, with or without Bortezomib or Daratumumab). The primary outcome was clinically significant infection within 180 days. Multivariable logistic regression identified associated factors.
Results
A total of 75 kidney transplant recipients were included (median age 39 years, 59% male). Antibody-Mediated Rejection was the most common phenotype (48%). Within 180 days, 39 patients (52%) developed clinically significant infections. Bacterial infections predominated, followed by viral and fungal infections; the most frequent syndromes were urinary tract infection, Cytomegalovirus Infection, BK Virus Infection, and pneumonia. Infection was more common in patients receiving ≥2 treatment hits (66% vs. 31%, p=0.004). Independent predictors were ≥2 hits (OR 3.9, 95% CI 1.4–10.8), lymphocyte count <800/µL (OR 3.3, 95% CI 1.2–9.1), and prior rejection episodes (OR 2.7, 95% CI 1.0–7.4). Among infected patients, 59% required hospitalization, 10% intensive care, and 5% died.
Conclusion
More than half of kidney transplant recipients developed clinically significant infections within 180 days after intensified treatment for allograft rejection. Greater treatment intensity, baseline lymphopenia, and prior rejection episodes were independently associated with infection and may help identify patients who require closer infectious surveillance
Acknowledgment
The authors acknowledge the support of the Kidney Transplant and Nephrology Services at the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán in Mexico City, Mexico.