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Multicenter Study
. 2025 Feb;44(2):831-838.
doi: 10.1007/s10067-024-07287-7. Epub 2024 Dec 24.

Frequency of severe infections in rheumatic disease patients receiving bDMARDs post-kidney transplantation: a multicenter study

Tuba Demirci Yıldırım  1 , Emel Oğuz Kökoğlu  2 , Belkıs Nihan Coşkun  3 , Derya Yıldırım  4 , Enes Basaran  5 , Abdurrahman Soner Şenel  2 , Yavuz Pehlivan  3 , Hamit Küçük  4 , Ayten Yazıcı  5 , Timuçin Kaşifoğlu  6 , İsmail Sarı  7
Affiliations
Multicenter Study

Frequency of severe infections in rheumatic disease patients receiving bDMARDs post-kidney transplantation: a multicenter study

Tuba Demirci Yıldırım et al. Clin Rheumatol. 2025 Feb.

Abstract

Objectives: To evaluate the incidence and characteristics of severe infections in rheumatic patients receiving biologic disease-modifying anti-rheumatic drugs (bDMARDs) after kidney transplantation.

Methods: This multicenter, retrospective study included 38 patients who had undergone kidney transplantation and received bDMARDs for rheumatic diseases. Demographic, clinical, and treatment data were collected. Severe infections were defined as those requiring hospitalization, and the incidence of severe infections was calculated per 100 patient years. Risk factors for severe infections were analyzed.

Results: Of the 38 patients (median age 40.5 years), 52.6% experienced severe infections, with a total of 39 severe infection episodes. The incidence of severe infections was 26.2 per 100 patient-years. The most common infections were urinary tract infections (43.5%) and pneumonia (30.8%). Familial Mediterranean Fever (FMF) was the most common rheumatic disease (57.9%), and the median disease duration was 18.5 years. Most patients (68.4%) were using IL-1 inhibitors, and 31.6% were on anti-TNF therapy. There was no significant difference between patients with and without infections in terms of gender, pre-transplant biological therapy use, or type of biological therapy used. Four patients (11%) died from infection-related complications, including coronavirus disease-19 (COVID-19).

Conclusion: Rheumatic patients receiving bDMARDs post-kidney transplantation have a high risk of severe infections. The concurrent use of immunosuppressive therapy and bDMARDs may further increase this risk, necessitating close infection monitoring and management. Key Points • Rheumatic patients treated with biologic disease-modifying anti-rheumatic drugs (bDMARDs) following kidney transplantation face a heightened risk of severe infections. • The concurrent use of immunosuppressive therapy and bDMARDs may further increase this risk. • Individualized treatment strategies are essential to balance the benefits of bDMARDs with the potential for severe infectious complications.

Keywords: Biologic disease-modifying anti-rheumatic drugs (bDMARDs); Kidney transplantation; Rheumatic diseases; Severe infection.

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Conflict of interest statement

Declarations. Authors’ declaration: The authors declare that the submitted work is their own and that copyright has not been breached in seeking its publication. They confirm that the article is an original work, has not been published before, and is not being considered for publication elsewhere in its final form, in either printed or electronic media. Competing interest: The authors declare no conflict of interest.

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