Session Name: Kidney Immunosuppression: Induction Therapy
Session Date & Time: None. Available on demand.
*Purpose: The optimal induction agent for kidney transplantation of hepatitis C virus nucleic acid test positive donors to negative recipients (HCV NAT D+/R-) is unknown. Achievement of HCV cure with directed acting antivirals (DAA) posttransplant has been reported in HCV NAT D+/R- kidney transplant recipients who received antithymocyte globulin (ATG) induction, yet theoretical concerns for over immunosuppression with alemtuzumab (ALEM) exist. We sought to compare ALEM vs ATG induction on HCV clearance and transplant outcomes in a cohort of HCV NAT D+/R- kidney transplant recipients.
*Methods: A single center, retrospective analysis comparing ALEM vs ATG induction in HCV NAT D+/R- adult kidney transplant recipients from July 2018 to December 2020 was conducted. Multi-organ transplant recipients were excluded. Maintenance therapy included tacrolimus, mycophenolate, and a 3-day steroid taper. DAA were determined by HCV genotype and payer preference. The primary outcome was achievement of sustained virologic response 12 weeks (SVR12) after therapy completion.
*Results: 20 recipients were included (7 ALEM, 13 ATG); 15 reached SVR12 at the time of data analysis. There were no differences in baseline characteristics between groups (Table 1). The majority of recipients were treated with glecaprevir/pibrentasvir for 12 weeks, initiated at a mean of 44 days posttransplant (range 22-88 days). There was no difference in achievement of SVR12 between groups (100% ALEM vs 100% ATG). Biopsy proven acute rejection within 6 months occurred in one recipient in each group. The recipient in the ALEM group who developed antibody mediated rejection was highly sensitized prior to transplant. One recipient in the ATG group experienced an adverse event from DAA therapy leading to its discontinuation.
*Conclusions: In HCV NAT D+/R- kidney transplant recipients initiated on a DAA posttransplant, the use of ALEM induction did not impact HCV clearance or transplantation outcomes compared to ATG induction in this limited series.
To cite this abstract in AMA style:Walter K, Mincemoyer L, Giang J, Suero J, Shah N, Szempruch K. Alemtuzumab vs Antithymocyte Globulin Induction in Hepatitis C Viremic Donors to Hepatis C Negative Kidney Transplant Recipients [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/alemtuzumab-vs-antithymocyte-globulin-induction-in-hepatitis-c-viremic-donors-to-hepatis-c-negative-kidney-transplant-recipients/. Accessed September 23, 2021.
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