Hypocomplementemia in Kidney Transplant Recipients: Impact on the Risk of Infectious Complications

Authors

  • M. Fernández-Ruiz,

    Corresponding author
    • Unit of Infectious Diseases, Instituto de Investigación Hospital “12 de Octubre” (i+12), Hospital Universitario “12 de Octubre”, School of Medicine, Universidad Complutense, Madrid, Spain
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  • F. López-Medrano,

    1. Unit of Infectious Diseases, Instituto de Investigación Hospital “12 de Octubre” (i+12), Hospital Universitario “12 de Octubre”, School of Medicine, Universidad Complutense, Madrid, Spain
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  • P. Varela-Peña,

    1. Department of Immunology, Instituto de Investigación Hospital “12 de Octubre” (i+12), Hospital Universitario “12 de Octubre”, School of Medicine, Universidad Complutense, Madrid, Spain
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  • J. M. Morales,

    1. Department of Nephrology, Instituto de Investigación Hospital “12 de Octubre” (i+12), Hospital Universitario “12 de Octubre”, School of Medicine, Universidad Complutense, Madrid, Spain
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  • A. García-Reyne,

    1. Unit of Infectious Diseases, Instituto de Investigación Hospital “12 de Octubre” (i+12), Hospital Universitario “12 de Octubre”, School of Medicine, Universidad Complutense, Madrid, Spain
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  • R. San Juan,

    1. Unit of Infectious Diseases, Instituto de Investigación Hospital “12 de Octubre” (i+12), Hospital Universitario “12 de Octubre”, School of Medicine, Universidad Complutense, Madrid, Spain
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  • C. Lumbreras,

    1. Unit of Infectious Diseases, Instituto de Investigación Hospital “12 de Octubre” (i+12), Hospital Universitario “12 de Octubre”, School of Medicine, Universidad Complutense, Madrid, Spain
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  • D. Lora-Pablos,

    1. Unit of Clinical Research, Instituto de Investigación Hospital “12 de Octubre” (i+12), Hospital Universitario “12 de Octubre”, School of Medicine, Universidad Complutense, Madrid, Spain
    2. CIBER de Epidemiología y Salud Pública (CIBERESP)
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  • N. Polanco,

    1. Department of Nephrology, Instituto de Investigación Hospital “12 de Octubre” (i+12), Hospital Universitario “12 de Octubre”, School of Medicine, Universidad Complutense, Madrid, Spain
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  • A. Andrés,

    1. Department of Nephrology, Instituto de Investigación Hospital “12 de Octubre” (i+12), Hospital Universitario “12 de Octubre”, School of Medicine, Universidad Complutense, Madrid, Spain
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  • E. Paz-Artal,

    1. Department of Immunology, Instituto de Investigación Hospital “12 de Octubre” (i+12), Hospital Universitario “12 de Octubre”, School of Medicine, Universidad Complutense, Madrid, Spain
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  • J. M. Aguado

    1. Unit of Infectious Diseases, Instituto de Investigación Hospital “12 de Octubre” (i+12), Hospital Universitario “12 de Octubre”, School of Medicine, Universidad Complutense, Madrid, Spain
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  • This study was partially presented at the 50th Annual Interscience Congress on Antimicrobial Agents and Chemotherapy (ICAAC), Boston (September 12–15, 2010) and at the 24th International Congress of The Transplantation Society (TTS), Berlin (July 15–19, 2012).

Corresponding author: Mario Fernández-Ruiz

mario_fdezruiz@yahoo.es

Abstract

The usefulness of monitoring of complement levels in predicting the occurrence of infection in kidney transplant (KT) recipients remains largely unknown. We prospectively assessed serum complement levels (C3 and C4) at baseline and at months 1 and 6 in 270 patients undergoing KT. Adjusted hazard ratios (aHRs) for infection in each posttransplant period were estimated by Cox regression. The prevalence of C3 hypocomplementemia progressively decreased from 21.5% at baseline to 11.6% at month 6 (p = 0.017), whereas the prevalence of C4 hypocomplementemia rose from 3.7% at baseline to 9.2% at month 1 (p = 0.004). Patients with C3 hypocomplementemia at month 1 had higher incidences of overall (p = 0.002), bacterial (p = 0.004) and fungal infection (p = 0.019) in the intermediate period (months 1–6). On multivariate analysis C3 hypocomplementemia at month 1 emerged as a risk factor for overall (aHR 1.911; p = 0.009) and bacterial infection (aHR 2.130; p = 0.014) during the intermediate period, whereas C3 hypocomplementemia at month 6 predicted the occurrence of bacterial infection (aHR 3.347; p = 0.039) in the late period (>6 month). A simple monitoring strategy of serum C3 levels predicts the risk of posttransplant infectious complications in KT recipients.

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