Epstein-Barr virus (EBV) seronegative patients (pts) who receive a kidney from an EBV seropositive donor carry the highest risk for EBV-related PTLD. We report our experience with addition of anti-CMV immunoglobulin (anti-CMV Ig) to routine CMV antiviral prophylaxis in EBV high risk pts.
Methods: Data was collected on 1256 renal txp pts from 1998-2012. All pts received CMV prophylaxis with either valgancyclovir, gancyclovir, or acyclovir. 47 EBV high risk pts (ie, donor EBV seropositive to recipient EBV seronegative pts) were analyzed in 2 groups: pts receiving anti-CMV Ig (n=25) and those not receiving anti-CMV Ig (n=22). Anti-CMV Ig dosing was 100mg/kg at 1, 2, 4, 6, and 8 weeks then 50mg/kg at 12 and 16 weeks.
Results: Demographics and immunosuppression were similar between groups. Most pts received rabbit anti-thymocyte globulin (r-ATG), tacrolimus, MMF, and steroid withdrawal. A significantly higher incidence of PTLD occurred in pts not receiving anti-CMV Ig (23%) versus (vs) 0% in the anti-CMV Ig pts, p<0.01). EBV viremia was numerically higher in the no anti-CMV Ig pts vs the anti-CMV Ig pts (23% vs 8%, p =NS). Pt death occurred earlier in the no anti-CMV Ig pts (134 ± 59 days vs 2267 ± 596, p<0.0001) with 2 early deaths due to PTLD. Logistic regression showed anti-CMV Ig (but not age or rATG use) to be significant (odds ratio 0.11, p<0.03).
|Anti-CMV Ig (n=25)||No Anti-CMV Ig (n=22)||P|
|Mean age (yrs)||43±14||39±15||NS|
|African American||5 (20%)||5 (23%)||NS|
|Male||16 (63%)||13 (59%)||NS|
|Median Follow-up (days)||1949 (346-4012)||1063 (78-3911)||NS|
|Repeat Txp||1 (4%)||1 (4.5%)||NS|
|rATG induction||17 (68%)||17 (77%)||NS|
|Mean rATG dose (mg/kg)||5.2±1.4||5±1.2||NS|
|Acute rejection (AR)||4 (16%)||5 (23%)||NS|
|rATG for AR||33%||33%||NS|
|EBV viremia||2 (8%)||5 (23%)||NS|
|Mean time to EBV (days)||191±81||105±85||0.0009|
|PTLD Death Rate||NA||2/5 (40%)||NA|
|Mean time to Death in PTLD pts||NA||163±77||NA|
|Pt Survival||22 (88%)||18 (82%)||NS|
|DC-Graft Survival||23 (92%)||19 (86.5%)||NS|
Conclusion: The use of anti-CMV Ig in the first year post-txp is associated with a significant reduction in PTLD incidence in the presence of standard CMV antiviral prophylaxis. No significant effect was observed on graft or pt survival, but pt death appears to occur earlier in pts not receiving anti-CMV Ig. These data suggest that anti-CMV Ig exerts a protective effect on PTLD risk beyond that of standard CMV prophylaxis.
To cite this abstract in AMA style:Shields A, Woodle E, Alloway R, Safdar S, Huang S, Cardi M. Addition of Anti-CMV Ig to Routine CMV Prophylaxis in EBV High Risk Kidney Transplant Recipients Is Associated with Reduced PTLD Incidence [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/addition-of-anti-cmv-ig-to-routine-cmv-prophylaxis-in-ebv-high-risk-kidney-transplant-recipients-is-associated-with-reduced-ptld-incidence/. Accessed December 1, 2020.
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