EBV Sero-Positivity Does Not Reduce the Risk for EBV Viremia and/or Post-Transplant Lymphoproliferative Disorder (PTLD) in Patients (Pts) Receiving Belatacept (CTLA4Ig).
Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA.
Meeting: 2016 American Transplant Congress
Abstract number: B297
Keywords: Highly-sensitized, IVIG, Viral therapy
Session Information
Session Name: Poster Session B: PTLD/Malignancies: All Topics
Session Type: Poster Session
Date: Sunday, June 12, 2016
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Halls C&D
Introduction: CTLA4Ig is a novel immunosuppressive (IS) which acts through costimulatory blockade of T-cells and obviates the need for calcineurin inhibitor-based IS (CNI-IS). Despite benefits in long-term renal function, the drug is limited to EBV sero(+) pts due to an increased risk for PTLD. Here we explore the relationship between viral sero(+) for EBV & CMV at transplant and the risk for subsequent viremia and PTLD in kidney transplant pts receiving CTLA4Ig- vs. CNI-IS. Methods: EBV and CMV viremia by PCR, and the PTLD incidence were compared in the 2 pt groups. All 39 CTLA4Ig-IS (median 29M treatment) were EBV sero(+), while CMV serology was available in 23/39. All pts were >18 years and received anti-CD25, Thymoglobulin or Alemtuzumab induction, and CMV prophylaxis. Results: The results are shown in the Table. Briefly, The incidence of CMV- and EBV-PCR(+) was significantly greater in sero(-) than sero(+) in both groups. When the results were compared between CTLA4Ig- vs. CNI-IS, a significantly higher rate of CMV-PCR(+) was seen in CTLA4Ig- vs. CNI-IS among sero(-) pts (80% vs. 26%), while no difference were seen in CMV sero(+) pts. In contrast, EBV-PCR(+) was significantly greater in CTLA4Ig- vs. CNI-IS for EBV-sero+ patients (15% vs. 4%). PTLD was observed in 3 CTLA4Ig- vs. 0 in CNI-IS pts. Conclusions: CTLA4Ig inhibits establishment of CMV immunity in CMV sero(-) pts. EBV sero(+) pts treated with CTLA4Ig are at increased risk for EBV-PCR(+) and possibly PTLD. Among sero(+) pts, EBV-PCR(+), but not CMV-PCR(+), was significantly greater in CTLA4Ig- than CNI-IS, suggesting a dichotomy in immune responses to these viruses with EBV sero(+) seemingly not rendering protection in CTLA4Ig-treated pts.
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CTLA4Ig-IS |
CNI-IS |
p-value: CTLA4Ig vs. CNI |
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|
Sero+ |
Sero- |
Sero+ |
Sero- |
Sero+ |
Sero- |
|
CMV Serology at Tx, n (%) |
18 |
5 |
412 |
145 |
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|
|
CMV-PCR >30 copies/PCR, n (%) |
3 (17) |
4 (80)* |
52 (13) |
37 (26)* |
0.615 |
0.007 |
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|
|
|
|
|
|
|
EBV Serology at Tx, n (%) |
39 |
0 |
134 |
7 |
|
|
|
EBV-PCR >30 copies/PCR, n (%) |
6 (15) |
NA |
5 (4) |
3 (43)* |
0.009 |
NA |
|
PTLD, n (%) |
3 (8) |
NA |
0 (0) |
0 (0) |
0.001 |
NA |
|
|
*p<0.01: sero+ vs – in each group |
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CITATION INFORMATION: Choi J, Shin B, Kahwaji J, Ge S, Thomas D, Vo A, Galera O, Villicana R, Peng A, Jordan S, Toyoda M. EBV Sero-Positivity Does Not Reduce the Risk for EBV Viremia and/or Post-Transplant Lymphoproliferative Disorder (PTLD) in Patients (Pts) Receiving Belatacept (CTLA4Ig). Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:
Choi J, Shin B, Kahwaji J, Ge S, Thomas D, Vo A, Galera O, Villicana R, Peng A, Jordan S, Toyoda M. EBV Sero-Positivity Does Not Reduce the Risk for EBV Viremia and/or Post-Transplant Lymphoproliferative Disorder (PTLD) in Patients (Pts) Receiving Belatacept (CTLA4Ig). [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/ebv-sero-positivity-does-not-reduce-the-risk-for-ebv-viremia-andor-post-transplant-lymphoproliferative-disorder-ptld-in-patients-pts-receiving-belatacept-ctla4ig/. Accessed November 25, 2024.« Back to 2016 American Transplant Congress