Alemtuzumab Induction Is Associated With Higher Risk of Polyomavirrus Associated Nephropathy (PVAN) in Kidney Transplant Recipients

H. Wadei,¹ H. Saull,² C. Enderby,² M. Mai,¹ M. Prendergast,¹ T. Gonwa.¹

¹Transplant, Mayo Clinic, Jacksonville, FL
²Pharmacy, Mayo Clinic, Jacksonville, FL.

Meeting: 2015 American Transplant Congress

Abstract number: 426

Keywords: Induction therapy, Kidney transplantation, Polyma virus

Incidence of PVAN on protocol kidney biopsies with alemtuzumab induction is unknown.Methods:The 1-year risk of PVAN was retrospectively compared between 200 consecutive primary kidney recipients who received either rabbit anti-thymocyte globulin (rATG) (n=100) or almetuzumab (n=100). All patients received 5 days of corticosteroids, tacrolimus (target 8-10 ng/ml 1st month then 6-8 ng/ml) and mycophenolate mofetil (MMF) at 2 gr/d. Patients with PRA >20% were excluded. Plasma BK PCR and protocol biopsies were obtained at 1,4 and 12 months post-tx. PVAN was treated with immunosuppression (IS) reduction. Results: Patients' and transplant characteristics are presented in Table 1

Table 1: Baseline characteristics

	rATG (n=100)	Alemtuzumab (n=100)	P
Age (yr)	56±13	52.8 ± 13.6	0.1
% Male	53	57	0.6
% Caucasian	51	57	0.2
% Living donor	41	31	0.1
% Pre-emptive tx	24	24	1
% DCD	10	18	0.1
% DGF	8	16	0.08
% ≥3 HLA match	34	27	0.5
Cold ischemia time (hr)	10±8	11±7	0.1
Warm ischemia time (min)	37±13	39±12	0.3

DCD: donation after cadiac death; DGF: delayed graft functionAt 1- year, 34 and 28 patients developed BK viremia in the almetuzumab and rATG groups, respectively (P=0.3) but PVAN was more common in the alemtuzumab (P=0.01) (Figure 1) Acute cellular rejection (ACR) Banff IA or higher was more common in the alemtuzumab group (P=0.005) (figure 2) and was preceded by PVAN preceded in 11/19 (58%) of cases.At time of ACR, trough tacrolimus (6±2 vs 9±5 ng/ml, P=0.005) and daily MMF dose (1.2±0.6 vs 1.7±0.5, P=0.007) were lower in the almetuzumab group.Conclusions:1)Despite similar rates of BK viremia, alemtuzumab was associated with higher risk of PVAN on protocol biopsies.2)IS reduction following PVAN diagnosis contributed to higher rates of ACR in the almetuzumab group

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