*Purpose: The purpose of this study is to compare the outcomes of simultaneous pancreas and kidney transplant (SPK) recipients after two T-cell depleting induction agents: thymoglobulin (rATG) and alemtuzumab (ALM)

*Methods: In this retrospective cohort study, we evaluated SPK recipients transplanted at our center between 2000 and 2016. Patients were 18 years of age or older. All patients were maintained on TAC/MMF plus or minus prednisone.

*Results: Baseline characteristics are summarized in Table 1. Only 2 SPLK (living donor kidney) recipients received ALM. During the first 3-years of follow up, MMF doses were comparable between groups and TAC levels were higher in the rATG group only at 3 and 36 mos. More patients in the rATG group were on low dose prednisone during the first 6 mos posttransplant. The primary outcome was acute T-cell mediated rejection (TCMR) in pancreas allograft detected in for-cause biopsies. The incidence of pancreas TCMR was similar between the two induction groups (see figure).Similarly, pancreas graft survival was comparable between the two cohorts. Serum creatinine levels were comparable between groups, except being slightly higher in the rATG group at 3 and 6 mos.

*Conclusions: Our study suggests that the two current choices of T-cell depleting induction agents, rATG and ALM, are associated with similar pancreas allograft outcomes including similar rate of TCMR and graft failure risk. These two agents are also associated with similar renal allograft function. Because of limited numbers of biopsies evaluated for antibody-mediated rejection (ABMR) we could not examine the risk of ABMR associated with the two agents. Lower cost of the drug and single dose administration, provides an advantage for use of ALM as the induction agent for SPK. However, further studies are needed to examine the comparative risk of adverse effects.

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