Analysis of Induction Dose and Incidence of CMV Viremia in High Risk (HR; D+/R-) Renal Transplant Recipients
University of Pittsburgh Medical Center, Pittsburgh, PA
Meeting: 2022 American Transplant Congress
Abstract number: 1380
Keywords: Antilymphocyte antibodies, Cytomeglovirus, Rejection
Topic: Clinical Science » Kidney » 37 - Kidney Immunosuppression: Induction Therapy
Session Name: Kidney Immunosuppression: Induction Therapy
Session Type: Poster Abstract
Date: Monday, June 6, 2022
Session Time: 7:00pm-8:00pm
Presentation Time: 7:00pm-8:00pm
Location: Hynes Halls C & D
*Purpose: Depleting induction puts patients at risk of opportunistic infections. Our protocol aims for 5-6mg/kg cumulative dose of antithymocyte globulin(ATG) divided over 4 doses. It is unclear whether a lower ATG dose or non-depleting induction results in a lower incidence of CMV viremia in the first year after kidney transplant while still protecting against rejection.
*Methods: All CMV HR renal recipients transplanted between 1/2018 and 6/2020 were included. Data collected included demographics, PRA, ATG dose, incidence of CMV viremia, rejection episodes (Banff 1A or greater) in the first-yr post-transplant. A total of 94 patients were divided into two groups. Grp 1(n=68) received 5-6mg/kg ATG; grp 2(n=26) received 3mg/kg ATG(n=20) or basiliximab(n=6).
*Results: Baseline characteristics were similar between groups except that grp1 had a higher PRA and proportion of black patients. The incidence of CMV viremia was similar between groups and occurred at an average of 8 months post-transplant. There was a significantly higher incidence of rejection (Banff 1A or greater) in grp2. There was 1 episode of mixed rejection in grp2 and no pure ABMR. See table for multivariable analysis.
*Conclusions: Low dose ATG or basiliximab induction in CMV HR recipients may be associated with a 6-fold higher odds of rejection in the first-year post-transplant without offering protection against development of CMV viremia even in non-sensitized patients.
|Total (n=94)||Group 1 (n=68)||Group 2 (n=26)||p-value|
|PRA I,PRA II||19.5+-33.5,17+-33||0.5+-1.3,1+-1.9||0.005,0.01|
|Average total ATG dose||5.5mg/kg||2.3mg/kg|
|Total (n=94)||Group1 (n=68(||Group2 (n=26)||p-value|
|Rejection (Banff 1A or greater)||22(23.4%)||12(17.6%)||10(38.5%)||0.03|
|Average time to CMV (months)||7+-2.2||7+-2.2||8+-2.3||0.34|
|Age at transplant||0.07|
|Low dose ATG||6.1||(1.6-23.6)||0.008|
To cite this abstract in AMA style:Shimko K, Pittappilly M, Chowdhury R, Karimi H, Puttarajappa C, Wijkstrom M, Mehta R. Analysis of Induction Dose and Incidence of CMV Viremia in High Risk (HR; D+/R-) Renal Transplant Recipients [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/analysis-of-induction-dose-and-incidence-of-cmv-viremia-in-high-risk-hr-d-r-renal-transplant-recipients/. Accessed March 24, 2023.
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