{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T00:24:22Z","timestamp":1792628662005,"version":"4.5.0"},"reference-count":30,"publisher":"Wiley","license":[{"start":{"date-parts":[[2024,3,1]],"date-time":"2024-03-01T00:00:00Z","timestamp":1709251200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Journal of Transplantation"],"published-print":{"date-parts":[[2024,3,1]]},"abstract":"<jats:p>Introduction. The impact of renal allograft rejection treatment on infection development has not been formally defined in the literature. Methods. We conducted a retrospective cohort study of 185 rejection (case) and 185 nonrejection (control) kidney transplant patients treated at our institution from 2014 to 2020 to understand the impact of rejection on infection development. Propensity scoring was used to match cohorts. We collected data for infections within 6\u2009months of rejection for the cases and 18\u2009months posttransplant for controls. Results. In 370 patients, we identified 466 infections, 297 in the controls, and 169 in the cases. Urinary tract infections (38.9%) and cytomegalovirus viremia (13.7%) were most common. Cumulative incidence of infection between the case and controls was 2.17 (CI 1.54\u20133.05); <jats:inline-formula><a:math xmlns:a=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M1\"><a:mi>p<\/a:mi><a:mo>&lt;<\/a:mo><a:mn>0.001<\/a:mn><\/a:math><\/jats:inline-formula>. There was no difference in overall survival (HR 0.90, CI 0.49\u20131.66) or graft survival (HR 1.27, CI 0.74\u20132.20) between the groups. There was a significant difference in overall survival (HR 2.28, CI 1.14\u20134.55; <jats:inline-formula><c:math xmlns:c=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M2\"><c:mi>p<\/c:mi><c:mo>=<\/c:mo><c:mn>0.019<\/c:mn><\/c:math><\/jats:inline-formula>) and graft survival (HR 1.98, CI 1.10\u20133.56; <jats:inline-formula><e:math xmlns:e=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M3\"><e:mi>p<\/e:mi><e:mo>=<\/e:mo><e:mn>0.023<\/e:mn><\/e:math><\/jats:inline-formula>) when patients with infection were compared to those without. Conclusions. As previously understood, rejection treatment is a risk factor for subsequent infection development. Our data have defined this relationship more clearly. This study is unique, however, in that we found that infections, but not rejection, negatively impacted both overall patient survival and allograft survival, likely due to our institution\u2019s robust post-rejection protocols. Clinicians should monitor patients closely for infections in the post-rejection period and have a low threshold to treat these infections while also restarting appropriate prophylaxis.<\/jats:p>","DOI":"10.1155\/2024\/6663086","type":"journal-article","created":{"date-parts":[[2024,3,1]],"date-time":"2024-03-01T19:05:08Z","timestamp":1709319908000},"page":"1-9","source":"Crossref","is-referenced-by-count":7,"title":["Impact of Early Rejection Treatment on Infection Development in Kidney Transplant Recipients: A Propensity Analysis"],"prefix":"10.1155","volume":"2024","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2006-1236","authenticated-orcid":true,"given":"Simran","family":"Gupta","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA"},{"name":"Harvard Medical School, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan","family":"Gea-Banacloche","sequence":"additional","affiliation":[{"name":"Division of Clinical Research, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raymond L.","family":"Heilman","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Mayo Clinic Arizona, Phoenix, Arizona, USA"},{"name":"Transplant Center, Mayo Clinic Arizona, Phoenix, Arizona, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reena N.","family":"Yaman","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Mayo Clinic Arizona, Phoenix, Arizona, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hay Me","family":"Me","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Mayo Clinic Arizona, Phoenix, Arizona, USA"},{"name":"Transplant Center, Mayo Clinic Arizona, Phoenix, Arizona, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nan","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Quantitative Health Sciences, Mayo Clinic Arizona, Phoenix, Arizona, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Holenarasipur R.","family":"Vikram","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Mayo Clinic Arizona, Phoenix, Arizona, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lavanya","family":"Kodali","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Mayo Clinic Arizona, Phoenix, Arizona, USA"},{"name":"Transplant Center, Mayo Clinic Arizona, Phoenix, Arizona, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","reference":[{"key":"1","article-title":"Renal transplantation rejection","volume-title":"StatPearls","author":"R. H. Naik","year":"2023"},{"key":"2","article-title":"Acute transplantation rejection","volume-title":"StatPearls","author":"A. A. Justiz Vaillant","year":"2023"},{"key":"3","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2016.03.004"},{"key":"4","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2015.08.009"},{"key":"5","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.15898"},{"key":"6","volume-title":"OPTN\/SRTR 2019 Annual Data Report: Kidney","author":"U.S. Department of Health and Human Services"},{"key":"7","doi-asserted-by":"publisher","DOI":"10.3390\/jcm11051392"},{"key":"8","doi-asserted-by":"publisher","DOI":"10.1016\/j.ekir.2019.01.014"},{"key":"9","doi-asserted-by":"publisher","DOI":"10.1016\/j.ekir.2022.08.027"},{"key":"10","doi-asserted-by":"publisher","DOI":"10.1155\/2019\/7105084"},{"key":"11","doi-asserted-by":"publisher","DOI":"10.1097\/tp.0b013e3181661695"},{"key":"12","volume-title":"Infection in Kidney Transplantation. 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