Campath Induction With Triple Maintenance Therapy in African American Kidney Transplant Recipients: Less Infections But Worse Graft Survival
University of Maryland Medical Center, Baltimore, MD.
Meeting: 2015 American Transplant Congress
Abstract number: B301
Keywords: African-American, Induction therapy, Kidney transplantation, Outcome
Session Information
Session Name: Poster Session B: Late Breaking
Session Type: Poster Session
Date: Sunday, May 3, 2015
Session Time: 5:30pm-6:30pm
Presentation Time: 5:30pm-6:30pm
Location: Exhibit Hall E
Introduction:African American (AA) kidney transplant recipients (KTR) are at a higher risk for worse clinical outcomes vs non-AA. Strategies to improve outcomes in AA KTR have centered around providing increased immunosuppression in an effort to minimize rejection. With the recent increase in alemtuzumab use, we aimed to compare outcomes in AA vs non-AA KTR induced mainly with this agent and maintained on triple vs dual therapy, respectively.
Methods:Adult (≥18 yrs) primary KTR transplanted between 1/1/13-12/31/13 were included. KTR with a non-renal transplant or lost to follow-up within 1 yr were excluded. Outcomes assessed included 1 yr incidence of CMV and BKV infections, patient and graft survival, and biopsy-proven acute rejection (BPAR). All incidences were evaluated using chi-square.
Results:AA had statistically more HLA mismatches and deceased donors. AA received more lymphocyte-depleting induction and greater maintenance therapy with FK/MPA/Pred. More non-AA were CMV D+/R- but also D-/R-. Incidence of CMV viremia, tissue invasive and breakthrough CMV, as well as BK viremia and nephropathy were all similar between gps. BPAR and patient survival were also similar but graft survival was significantly inferior in AA.
| AA | Non-AA | |
| Mean age±SD | 52.4±13.5 | 56.9±13.3 |
| Male,% | 63.2 | 62.2 |
| PRA,% | ||
| 0 | 61.8 | 70.4 |
| ≥20 | 13.2 | 12.2 |
| HLA Mismatch,% | ||
| 0 | 6.6 | 8.2 |
| 4-6 | 77.6¥ | 52 |
| DD,% | 82.9¥ | 46.9 |
| CMV,% | ||
| D+/R- | 13.2¥ | 26.5 |
| D+ or -/R+ | 71.1¥ | 41.8 |
| Induction,% | ||
| Alemtuzumab | 81.6 | 74.5 |
| Simulect | 9.2¥ | 20.4 |
| Thymo | 9.2 | 5.1 |
| Maintenance,% | ||
| FK/MPA | 1.3¥ | 46.9 |
| FK/MPA/Pred | 98.7¥ | 53.1 |
| CMV viremia,% | 7.9 | 4.1 |
| Tissue invasive CMV,% | 1.3 | 2 |
| Breakthrough CMV,% | 1.3 | 1 |
| BK viremia,% | 13.2 | 14.3 |
| BK nephropathy,% | 6.6 | 8.2 |
| BPAR,% | 15.8 | 12.2 |
| Pt survival,% | 97.4 | 96.9 |
| Death-censored graft survival,% | 88.2¥ | 96.9 |
Conclusions:The incidence of CMV and BKV infections in AA induced primarily with alemtuzumab and maintained on triple therapy was surprisingly similar to that of non-AA maintained on dual therapy. Interestingly, the observed incidences of infections in both groups were lower than that reported in the literature. There were no differences in BPAR and patient survival between groups but AA had significantly worse graft survival. While more potent immunosuppression consisting of alemtuzumab and triple therapy in AA resulted in less infections without apparent change in BPAR and patient survival, it may jeopardize long term graft survival.
To cite this abstract in AMA style:
Gillespie M, Rasetto F, Masters B, Sparkes T, Ravichandran B, Moss M, Haririan A. Campath Induction With Triple Maintenance Therapy in African American Kidney Transplant Recipients: Less Infections But Worse Graft Survival [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/campath-induction-with-triple-maintenance-therapy-in-african-american-kidney-transplant-recipients-less-infections-but-worse-graft-survival/. Accessed November 21, 2024.« Back to 2015 American Transplant Congress