Background: VIs represent significant morbidity factors in KTx pts. DES followed by KTx with ATZ induction increased successful Tx rates in HS pts, but may increase risk for VIs due to severe lymphocyte depletion. Here, we report on the VI status, anti-viral immunity and other related findings in DES vs. non-DES KTx pts. Methods: CMV, EBV & BKV-PCR results, PTLD & BKV-associated nephropathy (BKAN) rates, graft & pt survivals, and antibody- (ABMR) & cell-mediated rejection (CMR) rates up to median 24M post-Tx in 372 DES & 538 non-DES pts were compared. 40 DES pts were monitored for lymphocyte subsets & CMV-specific T cell (CMV-T) activity by flow cytometry, and total IgG, anti-CMV & anti-EBV IgG by ELISA. Results: CMV (16% vs. 25%, p=0.04) & EBV viremia (3% vs. 11%, p=0.001) were significantly lower in DES pts, while BKV viremia (11% vs. 13%) & BKAN rate (1.1% vs. 1.9%) were similar. No pt developed PTLD. CMV-T cells were detected by 2M in 75% and by 3M post-Tx in 95% of CMV sero(+) DES pts. CMV sero(-) pts efficiently developed CMV-T cells post-ATZ. Most pts showed 20-50% of pre-DES NK cell levels by 1M and >50% by 3M post-Tx. Total IgG decreased by 15-20% at 12M post-Tx in DES pts, while no or minimal reduction of anti-CMV & anti-EBV IgG was observed. Significantly more DES pts developed ABMR (12% vs. 2%, p<0.001), while CMR rate was similar (11% vs. 14%). 2-year allograft (93% vs. 95%) & pt survivals (96% vs. 95%) were similar in both groups. Conclusions: IVIg+rituximab DES combined with ATZ induction with triple immunosuppression maintenance does not increase the risk for CMV, EBV & BKV viremia, PTLD & BKAN under anti-viral surveillance with anti-viral prophylaxis for 6M post-Tx and close viral-PCR monitoring for early detection & early intervention. Possible factors include, in addition to the above anti-viral surveillance, presence of memory CMV-T & likely EBV-T cells, NK cell-mediated ADCC despite T cell/B cell depletion, elimination of EBV & CMV reservoirs by rituximab & ATZ, and use of IVIg with anti-viral properties.

CITATION INFORMATION: Ge S, Shin B.-H, Mirocha J, Thomas D, Chu M, Rodriguez E, Chao C, Petrosyan A, Galera O, Vo A, Choi J, Peng A, Kahwaji J, Jordan S, Toyoda M. IVIg+Rituximab Desensitization (DES) Combined with Alemtuzumab (ATZ) Induction Does Not Increase Risk for Viral Infections (VIs) and Associated Complications in HLA-Sensitized (HS) Kidney Transplant Patients (KTx Pts). Am J Transplant. 2017;17 (suppl 3).

« Back to 2017 American Transplant Congress