Evaluation of Infectious and Malignant Complications in Elderly Renal Transplant Recipients Receiving Alemtuzumab Compared to Basiliximab

K. Lang¹, J. Shulte¹, K. Cunningham¹, C. D'Agostino¹, M. Kapugi¹, C. Kane¹, A. Novak¹, J. Leventhal²

¹Department of Pharmacy, Northwestern Memorial Hospital, Chicago, IL, ²Division of Transplant Surgery, Northwestern Memorial Hospital, Chicago, IL

Meeting: 2020 American Transplant Congress

Abstract number: 6

Keywords: Age factors, Elderly patients, Induction therapy, Post-transplant lymphoproliferative disorder (PTLD)

Session Information

Session Name: Kidney Immunosuppression: Induction Therapy

Session Type: Oral Abstract Session

Date: Saturday, May 30, 2020

Session Time: 3:15pm-4:45pm

Presentation Time: 3:27pm-3:39pm

Location: Virtual

*Purpose: The choice of induction immunosuppression can affect several outcomes after kidney transplant (KTx), especially for elderly recipients. For this population, there is limited data and consensus for depleting versus non-depleting strategies. We aimed to evaluate the infectious and malignant complications between alemtuzumab and basiliximab in elderly KTx recipients.

*Methods: Patients ≥ 65 years old who received alemtuzumab or basiliximab induction for their primary KTx from 2006 – 2018 were included. Per institution strategy, prior to 2014, all KTx recipients, regardless of age, received alemtuzumab. After 2014, elderly KTx recipients (≥65 years) received basiliximab. Infection and graft outcomes were analyzed at 1 year; malignant complications were analyzed at any time after transplant.

*Results: A total of 157 patients received alemtuzumab and 98 patients received basiliximab. Of the 255 patients, 132 (51.8%) experienced an infectious complication within 1 year. There was no difference in the overall incidence of infection, however more patients treated with alemtuzumab developed CMV viremia (14% vs 6.1%, p=0.05), and more patients treated with basiliximab developed urinary tract (19.7% vs 31.6%, p=0.031) and C. difficile infections (0.6% vs 8.2%, p=0.002). Malignancy developed in 62 (24.3%) patients. A lower proportion of patients in the alemtuzumab group had freedom from cancer at any time (Kaplan-Meier estimates, log rank p=0.041). Patients who received basiliximab were more likely to develop biopsy proven acute rejection (BPAR) at 1 year (35.7% vs.15.3%, p<0.001), but with no difference in 1-year and overall mortality (Kaplan-Meier estimates, log rank p=0.896).

*Conclusions: This analysis suggests induction with alemtuzumab may influence malignancy rates after transplant in elderly KTx recipients relative to basiliximab, without a significant impact on incidence of infection. Higher rates of BPAR were observed with basiliximab, however patient survival was similar. Consideration can be given to continue utilization of non-depleting induction immunosuppression in elderly KTx recipients to reduce malignant outcomes after transplant.

To cite this abstract in AMA style:

Lang K, Shulte J, Cunningham K, D'Agostino C, Kapugi M, Kane C, Novak A, Leventhal J. Evaluation of Infectious and Malignant Complications in Elderly Renal Transplant Recipients Receiving Alemtuzumab Compared to Basiliximab [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/evaluation-of-infectious-and-malignant-complications-in-elderly-renal-transplant-recipients-receiving-alemtuzumab-compared-to-basiliximab/. Accessed November 24, 2024.

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