*Purpose: The purpose of this study was to evaluate infectious and transplant outcomes exclusively in renal re-transplant patients who had received alemtuzumab for induction therapy.

*Methods: A single-center, observational, retrospective cohort study was performed on patients who underwent renal re-transplantation at the UNC Medical Center from April 1, 2014-November 1, 2018. Patients were included if they were 18 years of age or older, received alemtuzumab as an induction agent, and if they were repeat renal transplant patients. Exclusion criteria included dual solid organ transplant recipients and ABO-incompatible renal transplant patients. Patient data was collected from the UNC Medical Center electronic health record (EPIC). The primary endpoint was identification of infections (opportunistic infections, bacterial, viral, and fungal) within 12 months of renal re-transplant. The secondary endpoints were acute rejection, patient and graft survival, and development of de novo donor specific antibodies within 12 months of renal re-transplant. Descriptive statistics such as counts, means, and standard deviations were used to quantify the data.

*Results: Among our cohort of thirty-four patients, the most common infections encountered in descending order of frequency were urinary tract infection (29.4% of patients), CMV DNAemia (23.5% of patients), and BK virus (17.6% of patients with the majority having BK viremia). Donor specific antibodies (DSA’s) developed in 32.4% (n=11) of our patients. Of those who developed DSA, only one patient experienced rejection. One patient passed away but the cause of death was unrelated to transplant.

*Conclusions: The most common infections experienced by our cohort of thirty-four renal re-transplant patients were urinary tract infections, CMV DNAemia, and BK virus. No patients experienced HSV, VZV, EBV, or invasive fungal infections (candidemia, PJP, aspergillus, mucor, etc) despite the ability for alemtuzumab to cause extensive immunosuppression. One-third of the patients in our study cohort developed donor specific antibodies (DSA’s) following re-transplantation. Despite this, only one patient had a negative transplant outcome. This indicates that the development of DSA’s in renal re-transplant patients receiving alemtuzumab may not lead to as many transplant complications (graft failure, acute rejection) as we had originally thought.

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