Purpose of this study is to determine safety of Alemtuzumab (Ab) in elderly kidney recipients.

Methods

This is a retrospective single center cohort analysis concerning kidney transplant recipients. Multiple organ transplants, kidney re-transplantations, ABO incompatible, desensitized, positive crossmatch recipients or those treated with basiliximab/thymoglobulin were excluded from this study. Recipients received Ab 30mg single IV dose in the operating room with steroids for 4 days only (1 gram steroids), mycophenolic acid 1.5 mg/day, tacrolimus (Tac) 0.05 0.1 /kg/day, prophylaxis with valganciclovir and TMP/SMX, and viral screening (BK, CMV serum PCR). All patients were followed for graft function. Follow up was for 12 months. All rejections were biopsy confirmed. Study concerns adults only; Group 1 (G1) recipients 18–64 years old and Group 2 (G2) 65 and older.

T-test, Fisher exact and Mantel-Cox (survival) tests were used respectively (Prism).

Results

Age in years: G1 (n=167) median was 49, mean 46.5±12.3 with range 18-64 and G2 (n=49) median was 68, mean 69.1±3.5, range 65-80 (P<0.0001). G1 consisted of 77 (46%) females and G2 of 20 (40.8%), P=0.62. G1 received kidneys from 64 (38%) living donors and G2 from 18 (37%), P=0.87. Infection: Urinary tract infection was observed in 22 (13%) recipients of G1 and 14 (28.5%) of G2 (P=0.016). BKV blood PCR was positive in 32 (19%) of G1 recipients and 8 (16%) in G2 (P=0.83). Only 7 of G1 and 2 of G2 recipients developed BKV nephropathy (P=1). None of the grafts were lost to BKN. CMV was detected in blood in 19 recipients of G1 and in 4 of G2 (P=0.61). Mean Tac levels at 12 months were 6.7±0.17 for G1 and 5.5±0.39 ng/mL for G2 (P<0.01 for T-test but variances were not different, P=0.25). Creatinine levels at 12 months were not different (P=0.52), 1.7 vs. 1.6 mEq/dL respectively. Acute rejection was observed in 9 (5.3%) recipients of G1 and 3 (6%) of G2, P=0.7. Two recipients died in each group within a year, P=0.19. Graft survival was similar at 98 and 96% respectively(P=0.35).

Conclusion

Whereas elderly population experienced higher rate of urinary tract infection, the remainder of the comparisons were not different. Ab is a safe induction agent for elderly recipients.

CITATION INFORMATION: Toledo A., Szempruch K., Serrano P., Andreoni K., Kozlowski T. Alemtuzumab Induction is Effective and Safe in Elderly Kidney Transplant Recipients Am J Transplant. 2017;17 (suppl 3).

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