Biopsies for Delayed Graft Function After Alemtuzumab Induction in Kidney Transplantation: The Incidence of Early Rejection After Alemtuzumab Is Very Low but Not Negligible.
Imperial Kidney & Transplant Centre, Hammersmith Hospital, Imperial College Healthcare, London, United Kingdom.
Meeting: 2016 American Transplant Congress
Abstract number: A154
Keywords: Biopsy, Induction therapy, Kidney transplantation, Rejection
Session Information
Session Name: Poster Session A: Kidney: Acute Cellular Rejection
Session Type: Poster Session
Date: Saturday, June 11, 2016
Session Time: 5:30pm-7:30pm
Presentation Time: 5:30pm-7:30pm
Location: Halls C&D
Introduction
UK practice advocates transplant biopsy (Bx) at day 7, then weekly in the presence of delayed graft function (DGF) because if missed, early rejection adversely affects graft survival. Alemtuzumab induction is associated with very low early rejection rates. We analysed the findings of Bx done within 30 days of transplantation in a large cohort of patients, most of whom received Alemtuzumab induction with short (7 day) steroid exposure and Tacrolimus maintenance monotherapy.
Methods
Bx done within 30 days of transplantation were identified from histology and renal unit data. Bx for DGF were broadly defined as patients requiring dialysis after transplant or whose creatinine levels failed to fall promptly. The Bx findings were compared between Alemtuzumab-treated recipients and the smaller group who were transplanted under anti-IL2-R monoclonal antibody blockade induction (IL2RMoAb)/Tacrolimus/MMF. Patients desensitised for ABO or HLA incompatible transplants were excluded.
Results
1505 kidneys transplants were performed on 1470 patients between 01/11/2005 and 16/10/2015, including SPK recpients. 1286 were treated with Alemtuzumab, and 219 received IL2RMoAb. 392 patients had renal allograft Bx within the first 30 days; 326 Alemtuzumab treated (of which 174 were for broadly defined DGF) and 66 after IL2RMoAb (36 for DGF). The overall acute rejection rate at 30 days (including humoral and mixed rejection) in the Campath cohort was 2.7% (1.5% with any humoral element) and 9.6% (1.8% humoral) in the IL2R-MoAb group. Rejection during DGF after Alemtuzumab induction was found in 4% vs 33% of patients with DGF after IL2RMoAb
| ATI | CNI Tox |
Graft Pyelo/TMA Rec. disease |
Sub-rejn Infiltrate |
ACR | AHR/ Mixed |
||
| Alemtuzumab | DGF | 159 | 2 | 5 | 1 | 3 | 4 |
| Rise | 106 | 6 | 7 | 5 | 13 | 15 | |
| IL2RMoAb | DGF | 19 | 1 | 3 | 1 | 10 | 2 |
| Rise | 17 | 1 | 0 | 3 | 7 | 2 |
Discussion
Rejection during dialysis-requiring, or “failure to fall” DGF after Alemtuzumab induction is rare, but does occur, as do other conditions (graft pyelonephritis, and recurrent glomerular disease) whose detection on transplant biopsy will alter management. DGF>7 days remains an indication for kidney transplant biopsy after Alemtuzumab induction.
CITATION INFORMATION: McGuire E, Roufosse C, Cook T, Ashby D, Cairns T, Galliford J, Willicombe M, Taube D, McLean A. Biopsies for Delayed Graft Function After Alemtuzumab Induction in Kidney Transplantation: The Incidence of Early Rejection After Alemtuzumab Is Very Low but Not Negligible. Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:
McGuire E, Roufosse C, Cook T, Ashby D, Cairns T, Galliford J, Willicombe M, Taube D, McLean A. Biopsies for Delayed Graft Function After Alemtuzumab Induction in Kidney Transplantation: The Incidence of Early Rejection After Alemtuzumab Is Very Low but Not Negligible. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/biopsies-for-delayed-graft-function-after-alemtuzumab-induction-in-kidney-transplantation-the-incidence-of-early-rejection-after-alemtuzumab-is-very-low-but-not-negligible/. Accessed November 22, 2024.« Back to 2016 American Transplant Congress