Date: Sunday, June 2, 2019
Session Time: 4:30pm-6:00pm
Presentation Time: 5:06pm-5:18pm
Location: Veterans Auditorium
*Purpose: The safety of early steroid withdrawal (ESW) in African American (AA) deceased donor renal transplant recipients (DDRTs) is unclear. This study assessed the impact of ESW with alemtuzumab induction on graft outcomes of AA DDRTs as compared to non-AA.
*Methods: This was a single-center, retrospective, cohort study of de novo DDRTs transplanted 1/2011-9/2015. Adults aged 18-65 years received alemtuzumab and a 21-day prednisone withdrawal taper with tacrolimus and mycophenolate maintenance therapy. Exclusion criteria were pre-transplant steroid use, pre-existing donor specific antibodies (DSA), multi-organ transplant, primary non-function, and conversion from tacrolimus within 3 years. Graft loss, biopsy-proven acute cellular (ACR) and antibody-mediated rejection (AMR), and patient survival were evaluated at 1 and 3 years.
*Results: Baseline characteristics of the included 155 AA and 100 non-AA DDRTs are summarized in Table 1. Patients were followed for a median duration of 3.7 years. Maintenance immunosuppression was similar throughout the study period, with comparable prednisone reinitiation rates at 1 year (9.2% vs 10.3%, p=0.819) and 3 years (12.7% vs 13.9%, p=0.832). A total of 311 surveillance and for-cause biopsies were performed in the AA group and 180 in the non-AA group. There was no difference in graft loss at 1 year (2.6% vs 3%, p=1.000) or 3 years (10.3% vs 5%, p=0.164) (Figure 1). While glomerular filtration rate (GFR) was higher throughout the study period in AA DDRTs, the incidence of chronic AMR and Class II DSA development at 3 years was significantly greater (Table 2).
*Conclusions: These data suggest AA DDRTs undergoing ESW with alemtuzumab induction have similar graft survival at 3 years as non-AA DDRTs. However, the increased incidence of chronic AMR and DSA development raises concern, and longer follow-up is warranted to sufficiently assess graft outcomes. Further evaluation is needed to identify the subpopulation benefiting from steroid continuation.
To cite this abstract in AMA style:Lynn R, Ravichandran B, Sparkes T, Haririan A, Bromberg J, Casale J. Early Steroid Withdrawal in African American Deceased Donor Renal Transplant Recipients with Alemtuzumab Induction: Is Graft Loss on the Horizon? [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/early-steroid-withdrawal-in-african-american-deceased-donor-renal-transplant-recipients-with-alemtuzumab-induction-is-graft-loss-on-the-horizon/. Accessed April 15, 2021.
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