[The long-term infective complications in patients after kidney transplantation and photopheresis]

Abstract

Aim: to evaluate the influence of prophylactic use of photopheresis on the risk of long-term infective complications after kidney transplantation.

Materials and methods: The open cohort randomized study was conducted. A total of 60 recipients after cadaveric kidney allotransplantation from 30 donors were assessed. The patients were randomized into two groups (n=30). All transplants were paired, and one kidney was transplanted to patient in intervention group and the another one was transplanted to patient in control group. In the intervention group all patients received standard immunosuppression therapy (tacrolimus, mycophenolate, prednisone) and 10-15 sessions of photopheresis during first 6 months after the transplantation. In the control group only the immunosuppression therapy was given. The follow-up period ranged from 2 to 7 years, an average 4.5+/-2.0 years.

Results: The rate infective complications in the both groups gradually decreased as the postoperative period increased exponentially, but it was lower in the intervention group than in the control group. The rate of respiratory infection, asymptomatic bacteriuria and viremia, verified by the genetic amplification was 4, 2 and 1.5 times lower in the intervention group. The risk of clinically meaningful infection was significantly lower in the intervention group than in the control group: IRR 0.3888 (95% CI 0.2754; 0.5445; <0.0001). 6-year survival in the intervention group was 100% in comparison to 82.8% in the control group (95% CI 51.6; 93.16).

Conclusion: The prophylactic use of the photopheresis allows to decrease the risk of infective complications after the kidney transplantation.

Keywords: extracorporeal photochemotherapy; infective complications; kidney transplantation; photopheresis.