World journal of nephrology · 2026
Comparison of infectious complications following early versus late pulse steroid therapy in renal transplant recipients.
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Roy Shuvam, Behera M R, Kaul Anupma, Prasad Narayan, Bhadauria Dharmendra S, Patel Manas R, Kushwaha Ravi S, Yachha Monika, Yadav Priyank, Lal Hira
Аннотация
BACKGROUND: Renal transplant recipients are at increased risk of infections due to immunosuppression. Pulse steroid therapy, used to treat acute rejection, may further heighten this risk. However, the impact of the timing of pulse steroid therapy on infectious complications remains unclear.
AIM: To compare infectious complications following early vs late pulse steroid therapy in renal transplant recipients.
METHODS: This study included adult renal transplant recipients who received pulse steroid therapy either within 90 days (early) or after 90 days (late) post-transplantation between January 2016 and December 2020. Patients receiving both early and late pulse therapy were excluded. Infectious complications requiring hospitalization were recorded from the first pulse steroid dose until death or December 31, 2021. Infection burden was expressed as episodes per 100 patient-years, and incidence rate ratios (IRRs) with 95% confidence intervals (CI) were calculated.
RESULTS: A total of 128 patients were included (early: n = 84; late: n = 44). The overall infection rate was lower in the early group compared with the late group (42.64 episodes per 100 patient-years vs 68.68 episodes per 100 patient-years; IRR = 0.62, 95%CI: 0.46-0.83, P < 0.01). Rates of pneumonia (IRR = 0.44, 95%CI: 0.22-0.86, P = 0.02), sepsis (IRR = 0.35, 95%CI: 0.13-0.96, P = 0.04), and viral infections (IRR = 0.42, 95%CI: 0.19-0.91, P = 0.03) were also lower in the early group. Mortality was significantly higher in patients receiving late pulse steroid therapy (18.2% vs 4.8%, P = 0.02).
CONCLUSION: Late pulse steroid therapy in renal transplant recipients is associated with a significantly higher burden of infectious complications and mortality compared with early therapy. These findings highlight the need for enhanced surveillance and tailored infection prevention strategies following late intensification of immunosuppression.
AIM: To compare infectious complications following early vs late pulse steroid therapy in renal transplant recipients.
METHODS: This study included adult renal transplant recipients who received pulse steroid therapy either within 90 days (early) or after 90 days (late) post-transplantation between January 2016 and December 2020. Patients receiving both early and late pulse therapy were excluded. Infectious complications requiring hospitalization were recorded from the first pulse steroid dose until death or December 31, 2021. Infection burden was expressed as episodes per 100 patient-years, and incidence rate ratios (IRRs) with 95% confidence intervals (CI) were calculated.
RESULTS: A total of 128 patients were included (early: n = 84; late: n = 44). The overall infection rate was lower in the early group compared with the late group (42.64 episodes per 100 patient-years vs 68.68 episodes per 100 patient-years; IRR = 0.62, 95%CI: 0.46-0.83, P < 0.01). Rates of pneumonia (IRR = 0.44, 95%CI: 0.22-0.86, P = 0.02), sepsis (IRR = 0.35, 95%CI: 0.13-0.96, P = 0.04), and viral infections (IRR = 0.42, 95%CI: 0.19-0.91, P = 0.03) were also lower in the early group. Mortality was significantly higher in patients receiving late pulse steroid therapy (18.2% vs 4.8%, P = 0.02).
CONCLUSION: Late pulse steroid therapy in renal transplant recipients is associated with a significantly higher burden of infectious complications and mortality compared with early therapy. These findings highlight the need for enhanced surveillance and tailored infection prevention strategies following late intensification of immunosuppression.