Immunosuppression reduction in liver and kidney transplant recipients with suspected bacterial infection: A multinational survey

Daniel Shepshelovich, Noam Tau, Hefziba Green, Benaya Rozen-Zvi, Assaf Issaschar, Marco Falcone, Julien Coussement, Oren Zusman, Oriol Manuel, Eytan Mor, Julian Torre-Cisneros, Dafna Yahav*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: There is no consensus on the optimal management of immunosuppression during bacterial infections among solid organ transplant recipients. Methods: A multicenter, cross-sectional survey, of high-volume kidney and liver transplant centers across US and Europe. Structured questionnaires including six multiple-choice questions concerning the management of immunosuppression during infection were distributed among 381 centers. Results: A total of 124 (33%) centers fully completed the questionnaire: 67 liver, 57 kidney centers. Participating centers reported heterogenous approaches to immunosuppression management for all types of immunosuppressive drugs. Notably, kidney centers reported similar frequencies of either discontinuation (19%), continuation (19%), or dose reduction (17.5%) of antimetabolites; discontinuation only for life-threatening infection (17.5%) or case by case decisions (27%). Calcineurin inhibitors (CNI) management was heterogenous mostly among liver centers, with 8% discontinuing the CNI, 18% continuing, and 22% reducing dose. Heterogenous approaches to management of steroids and inhibitors of the mammalian target of rapamycin were also demonstrated. Conclusions: Immunosuppression management during bacterial infection is heterogenous in US and European centers. Immunosupression reduction (ISR) during infection is a common practice, though supported by limited evidence. Demonstrating high heterogeneity in the approach to ISR, together with the equivocal results of clinical studies, support consideration of an interventional clinical trial.

Original languageEnglish
Article numbere13134
JournalTransplant Infectious Disease
Issue number5
StatePublished - 1 Oct 2019


  • immunosuppression reduction
  • infection
  • kidney transplant
  • liver transplant


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