Alemtuzumab Induction Is Associated With a Lower Risk of Early Rehospitalization After Kidney Transplant

G. Dube,¹ D. Tsapepas,² Y. Coppleson,³ L. Ratner,⁴ D. Cohen,¹ S. Mohan.¹

¹Medicine, Columbia University Medical Center, New York, NY
²Pharmacy, New York-Presbyterian Hospital, New York, NY
³Quality and Patient Safety, New York-Presbyterian Hospital, New York, NY
⁴Surgery, Columbia University Medical Center, New York, NY.

Meeting: 2015 American Transplant Congress

Abstract number: C63

Keywords: Induction therapy, Kidney transplantation, Resource utilization

Early rehospitalizations within the first 30 days (R-30D) are common after kidney transplant. R-30D are costly and associated with an increased risk of graft failure and death. Registry analyses have found that use of an induction agent is associated with a slight decrease in the risk of R-30D compared with no induction agent. However, there are few data comparing the relative risk of R-30D between different induction agents. Rabbit antithymocyte globulin (RATG) is the most frequently used induction agent, though the use of alemtuzumab (A) has increased over the past decade.

Methods: Several years ago we switched our standard induction agent from RATG to A. We compared rates of R-30D among patients receiving A and RATG and analyzed risk factors for R-30D. Maintenance immunosuppression was similar in both groups (tacrolimus, mycophenolate & rapid steroid withdrawal), as were recipient and donor selection criteria. We compared rates of R-30D among patients receiving A and RATG and analyzed risk factors for R-30D.

Results: Recipient and transplant characteristics are shown in table.

	RATG	A	P value
N	220	205
Age (y)	51.7 ± 14.7	52.9 ± 13.5	0.39
Female	38.2%	37.6%	0.90
BMI	27.9 ± 5.1	28.1 ± 5.7	0.75
Living donor	50.9%	50.2%	0.89
Diabetic	28.6%	28.7%	0.97
Preemptive transplant	20.9%	22.9%	0.62
Retransplant	11.8%	11.2%	0.88
Donor creatinine	2.3 ± 2.1	2.0± 1.8	0.26
Cold ischemia time (h)	34.5 ± 9.7	33.7± 9.9	0.55
DSA	19.1%	14.2%	0.17
DGF	28.2%	28.9%	0.89

There were no differences in initial length of stay or demographics between the two groups. Recipients treated with A had a lower risk of rejection in the first month (3.9% vs. 9.1% with RATG, p=0.03). R-30D were significantly less common with A when compared with RATG (17.1% vs. 27.7%, p=0.01) After adjusting for recipient age, donor type, DGF, rejection within 30 days and presence of DSA, the odds ratio for readmission with RATG was 1.78.

Conclusions: The risk of early R-30D following kidney transplant is significantly higher with RATG compared with A. Further analysis is required to determine if choice of induction agent affects reasons for R-30D , and whether the lower rate of R-30D in this cohort is associated with improved patient and allograft survival.

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