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 Information
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 | |
| SexF,M | 35(37.2%),59(62.8%) | 27(39.7%),41(60.3%) | 8(30.8%),18(69.2%) | 0.42 |
| RaceW,B | 84(89.4%),10(10.6%) | 58(85.3%),10(14.7%) | 26(100%),0(0%) | 0.04 |
| Donor TypeL,D | 30(31.9%),64(68.1%) | 18(26.5%),50(73.5%) | 12(46.2%),14(53.8%) | |
| Age (yrs) | 51+-16 | 49+-14 | 58+-19 | 0.99 |
| PRA I,PRA II | 19.5+-33.5,17+-33 | 0.5+-1.3,1+-1.9 | 0.005,0.01 | |
| DGF | 17(18.1%) | 11(16.2%) | 6(23.1%) | 0.34 |
| 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 |
| CMV viremia | 30(31.9%) | 23(33.8%) | 7(26.9%) | 0.52 |
| Average time to CMV (months) | 7+-2.2 | 7+-2.2 | 8+-2.3 | 0.34 |
| Variable | p-value |
| Age at transplant | 0.07 |
| PRAI | 0.79 |
| PRAII | 0.37 |
| Sex | 0.36 |
| Race | 0.31 |
| Variable | OR | 95% CI | p-value |
| Age | 0.94 | (0.91-0.98) | 0.006 |
| 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.« Back to 2022 American Transplant Congress