*Purpose: Polyomavirus associated nephropathy (PVAN) is an opportunistic infection associated with graft loss and rejection. Due to limited treatment options, identifying kidney transplant recipients at higher risk for developing PVAN is crucial to both early diagnosis and timely reductions of maintenance immunosuppression. While greater intensity immunosuppression has previously been associated with increased risk of polyomavirus, it remains unclear which immunosuppressive agents directly contribute to this risk. The purpose of this retrospective chart review is to assess if alemtuzumab, a monoclonal antibody with profound lymphocyte-depleting effect, accelerates time to BK virus replication or severity of PVAN among kidney transplant recipients compared to those who received rATG induction.

*Methods: We performed a retrospective chart review of kidney transplant recipients 18-80 years of age from August 2010-2019 who received depleting induction with subsequent biopsy confirmed PVAN and BK PCR viral loads >1,500 copies/mL.

*Results: There were 47 kidney transplant recipients identified who received depleting induction and later developed PVAN. Of these, 34 patients received alemtuzumab and 13 patients received rATG 6mg/kg (IBW). There were no differences in baseline characteristics between those who received alemtuzumab compared to rATG induction. Maintenance immunosuppression at the time of BK virus diagnosis did not differ between groups. [Table 1] Patients who received alemtuzumab induction did not develop BK virus at a faster rate than those who received rATG induction (211 days vs. 260 days, p=0.248). PVAN was not more severe in the alemtuzumab group, defined by no differences in polyomavirus pattern (p=0.2), SV40% (p=0.468), interstitial fibrosis, or tubular atrophy (p=0.864).

*Conclusions: Alemtuzumab was not observed to be associated with an accelerated rate of developing BK virus or increased severity of PVAN when compared to rATG induction.

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