Delayed graft function [DGF] is associated with rejection [AR] and allograft loss. It is postulated that ischaemic injury up regulates the expression of allograft MHC leading to an increased risk of rejection.
AR occurs later in patients receiving Alemtuzumab (ALZ) than with other induction agents and the aim of this study was to compare the impact of DGF on the incidence of rejection in recipients of deceased donor kidneys (DDTx) receiving either ALZ or an IL2 receptor antagonist (IL2Ra).
We retrospectively studied 390 patients [m260, f130, mean age was 48.8 ± 13.7 yrs] who received a DDTx at our centre between 2005 and 2011. We excluded all patients with preformed DSAbs detected by luminex. 332(85.1%) and 58(14.9%) patients received ALZ and IL2Ra induction respectively. All patients received tacrolimus based maintenance immunotherapy with corticosteroids for one week only. The mean follow up was 41.9 ± 19.8 months.
118/390 (30.3%) of patients had DGF with no difference between the ALZ and IL2Ra groups, p=0.99.
There was no difference in patient survival at 3 yrs between the groups, being 97.3% and 89.7% in the ALZ group with no DGF and DGF respectively; 91.0% and 94.4% in the IL2Ra group with no DGF and DGF respectively, p=0.1.
Allograft survival was inferior in the patients with DGF irrelevant of induction, censored allograft survival being 91.7%, 82.5% in the ALZ group with no DGF and DGF respectively and 88.6% and 82.6% in the IL2Ra group with no DGF and DGF respectively, p=0.02.
Patients who received an IL2Ra were at highest risk of rejection in the first 3 months post transplant, p=0.03 as shown in figure1.
This difference is subsequently lost and the 3 year rejection free survival is 79.6% in the ALZ with no DGF, 75.1% in the ALZ with DGF, 76.5% in the Il2Ra with no DGF and 70.7% in the IL2Ra group with DGF, p=0.4.
This study shows that ALZ induction mitigates the risk of rejection associated with DGF in the early post-transplant period but that this is not sustained.
To cite this abstract in AMA style:Goodall D, Willicombe M, Rizzello A, Galliford J, McLean A, Taube D. Alemtuzumab Mitigates the Risk of Early Rejection Associated with Delayed Graft Function in Deceased Donor Renal Transplantation [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/alemtuzumab-mitigates-the-risk-of-early-rejection-associated-with-delayed-graft-function-in-deceased-donor-renal-transplantation/. Accessed October 27, 2020.
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