Alemtuzumab versus Antithymocyte Globulin Induction Immunosuppression in Highly Sensitized Kidney Transplant Recipients
1Tampa General Hospital, Tampa, FL, 2Florida Kidney Physicians, Tampa, FL
Meeting: 2019 American Transplant Congress
Abstract number: B204
Keywords: Antilymphocyte antibodies, Immunosuppression, Kidney, Sensitization
Session Information
Session Name: Poster Session B: Kidney Immunosuppression: Induction Therapy
Session Type: Poster Session
Date: Sunday, June 2, 2019
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall C & D
*Purpose: Lymphocyte depleting agents such as rabbit anti-thymocyte globulin (rATG) and alemtuzumab are used for induction in highly sensitized (PRA ≥30%) kidney transplant recipients (KTRs). Although studies have shown alemtuzumab safe and efficacious in highly sensitized KTRs, there is no consensus on a preferred lymphocyte depleting agent in this population. The purpose of this study is to compare the incidence of biopsy-proven acute rejection (BPAR) 1-year post-transplant in highly sensitized KTRs who received either alemtuzumab or rATG for induction immunosuppression.
*Methods: A retrospective, single center study of adult KTRs who received either rATG from 11/2011 to 12/2015 or alemtuzumab from 1/2015 to 7/2017 for induction immunosuppression was conducted. Highly sensitized patients were defined by a PRA ≥30%. Patients were excluded if they did not meet institutional goal rATG dosing regimen of ≥4.5 mg/kg based on actual body weight. Incidence of BPAR, allograft function, incidence of infection and malignancy, and patient and graft survival were analyzed.
*Results: A total of 138 KTRs were included in the study with 58.7% (n=81) receiving alemtuzumab and 41.3% (n=57) receiving rATG. Baseline characteristics and maintenance immunosuppression are found in Table 1. The rATG cohort, compared to alemtuzumab treated patients, had numerically lower incidences of BPAR at 6 months (3.5% vs 6.2%, p=0.70) and 1 year (3.5% vs 11.1%, p=0.12). Additionally, antibody-mediated rejection (AMR) at 1-year occurred less frequently in the rATG cohort (1.8% vs 7.4%, p=0.24). Patients that received rATG induction had significantly better allograft function at 3, 6, 9 and 12 months post-transplant (Figure 1). There were no differences in the incidence of death, death-censored graft loss, or infectious complications at 1 year between the two cohorts.
*Conclusions: The findings support the use of rATG for induction immunosuppression in highly sensitized KTRs. Patients who received rATG induction had significantly higher eGFRs compared to alemtuzumab, with lower rates of BPAR and AMR at 1 year.
To cite this abstract in AMA style:
Brueckner A, Yanqui E, Truong C, Baliga R, Bowman L. Alemtuzumab versus Antithymocyte Globulin Induction Immunosuppression in Highly Sensitized Kidney Transplant Recipients [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/alemtuzumab-versus-antithymocyte-globulin-induction-immunosuppression-in-highly-sensitized-kidney-transplant-recipients/. Accessed May 12, 2025.« Back to 2019 American Transplant Congress