Do Powerful Induction Antibodies Increase Post Renal Transplant Infections?
Transplant Institute, Tulane University School of Medicine, New Orleans, LA.
Meeting: 2016 American Transplant Congress
Abstract number: D270
Keywords: Cytomeglovirus, Induction therapy, Infection, Kidney transplantation
Session Information
Session Name: Poster Session D: Poster Session II: Kidney Complications-Other
Session Type: Poster Session
Date: Tuesday, June 14, 2016
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Halls C&D
Purpose: Infection is one of the most common and costly complications of solid organ transplantation. Alemtuzemab (AL) is a powerful antibody that significantly reduced rejection rates in renal transplant recipients but has been frequently attributed to increased infection rates.
Methods: Multivariate analysis (MVA) of etiologic factors for the occurrence of infection in 717 consecutive adult renal transplant recipients.
Results: The incidence of infection was 36% in 449 alemtuzumab (AL) and 53% in 268 non-alemtuzumab (NC) induction patients (p<0.001). Table 1: Recipient demographics and Transplant outcomes: Focal Glomerular Sclerosis (FSGS), cadaveric (CAD), antibody (Ab), delayed graft function (DGF), mycophenolic acid mofetil (MMF)
| Age | DM | FSGS | Rejection | CAD graft | HLA mismatch | AL Ab | |
| Infections | 51 | 34% | 3% | 32% | 19% | 3.98 | 28% |
| No infections | 49 | 28% | 8% | 21% | 10% | 3.65 | 46% |
| p-value | 0.043 | 0.065 | 0.005 | 0.002 | 0.001 | 0.024 | 0.001 |
| DGF | CMV AG+ | 1wk Fk | High-dose MMF | Re-admit 1mos | Re-admit 3mos | Graft loss | |
| Infections | 34% | 33% | 10.4 | 42% | 54% | 110% | 20% |
| No infections | 26% | 8% | 10.7 | 32% | 20% | 38% | 13% |
| p-value | 0.036 | 0.001 | 0.532 | 0.008 | 0.001 | 0.001 | 0.011 |
MVA for infection: age p=0.029, CAD p=0.015, NC induction p=0.01, rejection p=0.009, WBC p<0.001 and FK p=0.02. Wound: DM p=0.042 and UTI p<0.001. Viral: CMV Ag p<0.001, neupogen p=0.029, rejection p=0.003 and live donor kidney p=0.003. Fungal: Liver disease p<0.001, hepatitis B p=0.004, Chronic rejection P=0.04 and readmit < 1 yr p=0.001. Sepsis: Valve disease p=0.002, liver disease 0.003, FSGS p=0.005, Fungal infection p=0.037 and CMV Ag p<0.001. Infection occurring <30 days after transplant: gov't insure p=0.034, CAD p=0.004, warm time p=0.005, WBC p=0.038 and MMF p=0.001 and >30 days: CAD p=0.008, WBC p<0.001, MMF p<0.001 and then chronic rejection p=0.023.
Conclusions: Alemtuzumab induction does not lead to a higher incidence of post transplant infections. The use of strong induction antibodies results in lower rejection rates and lower cumulative dose immunosuppression. This study also identified additional significant risk factors associated with impaired immune- competence including advanced age, CMV antigenemia, valve disease, liver disease or neutropenia.
CITATION INFORMATION: John M, Dortonne I, Kim B, Li C, Killackey M, Paramesh A, Lee B, Zhang R, Parker G, Buell J. Do Powerful Induction Antibodies Increase Post Renal Transplant Infections? Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:
John M, Dortonne I, Kim B, Li C, Killackey M, Paramesh A, Lee B, Zhang R, Parker G, Buell J. Do Powerful Induction Antibodies Increase Post Renal Transplant Infections? [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/do-powerful-induction-antibodies-increase-post-renal-transplant-infections/. Accessed November 22, 2024.« Back to 2016 American Transplant Congress