Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Halls C&D
- Examining the Risk for Post-Transplant Viral Infections and Lymphoproliferative Disorder (PTLD) in Kidney Transplant Patients (Pts) Receiving Calcineurin Inhibitor-Based Immunosuppression (CNI-IS) Compared to Belatacept (CTLA4Ig).
- Kidney Re-Transplantation (reTx) in Patients with Post-Transplant Lymphoproliferative Disorder (PTLD)
Introduction: CTLA4Ig is a novel immunosuppressive (IS) which acts through costimulatory blockade of T-cells and obviates the need for calcineurin inhibitor-based IS (CNI-IS). Despite benefits in long-term renal function, the drug is limited to EBV sero(+) pts due to an increased risk for PTLD. Here we explore the relationship between viral sero(+) for EBV & CMV at transplant and the risk for subsequent viremia and PTLD in kidney transplant pts receiving CTLA4Ig- vs. CNI-IS. Methods: EBV and CMV viremia by PCR, and the PTLD incidence were compared in the 2 pt groups. All 39 CTLA4Ig-IS (median 29M treatment) were EBV sero(+), while CMV serology was available in 23/39. All pts were >18 years and received anti-CD25, Thymoglobulin or Alemtuzumab induction, and CMV prophylaxis. Results: The results are shown in the Table. Briefly, The incidence of CMV- and EBV-PCR(+) was significantly greater in sero(-) than sero(+) in both groups. When the results were compared between CTLA4Ig- vs. CNI-IS, a significantly higher rate of CMV-PCR(+) was seen in CTLA4Ig- vs. CNI-IS among sero(-) pts (80% vs. 26%), while no difference were seen in CMV sero(+) pts. In contrast, EBV-PCR(+) was significantly greater in CTLA4Ig- vs. CNI-IS for EBV-sero+ patients (15% vs. 4%). PTLD was observed in 3 CTLA4Ig- vs. 0 in CNI-IS pts. Conclusions: CTLA4Ig inhibits establishment of CMV immunity in CMV sero(-) pts. EBV sero(+) pts treated with CTLA4Ig are at increased risk for EBV-PCR(+) and possibly PTLD. Among sero(+) pts, EBV-PCR(+), but not CMV-PCR(+), was significantly greater in CTLA4Ig- than CNI-IS, suggesting a dichotomy in immune responses to these viruses with EBV sero(+) seemingly not rendering protection in CTLA4Ig-treated pts.
p-value: CTLA4Ig vs. CNI
CMV Serology at Tx, n (%)
CMV-PCR >30 copies/PCR, n (%)
EBV Serology at Tx, n (%)
EBV-PCR >30 copies/PCR, n (%)
PTLD, n (%)
*p<0.01: sero+ vs – in each group
CITATION INFORMATION: Choi J, Shin B, Kahwaji J, Ge S, Thomas D, Vo A, Galera O, Villicana R, Peng A, Jordan S, Toyoda M. EBV Sero-Positivity Does Not Reduce the Risk for EBV Viremia and/or Post-Transplant Lymphoproliferative Disorder (PTLD) in Patients (Pts) Receiving Belatacept (CTLA4Ig). Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:Choi J, Shin B, Kahwaji J, Ge S, Thomas D, Vo A, Galera O, Villicana R, Peng A, Jordan S, Toyoda M. EBV Sero-Positivity Does Not Reduce the Risk for EBV Viremia and/or Post-Transplant Lymphoproliferative Disorder (PTLD) in Patients (Pts) Receiving Belatacept (CTLA4Ig). [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/ebv-sero-positivity-does-not-reduce-the-risk-for-ebv-viremia-andor-post-transplant-lymphoproliferative-disorder-ptld-in-patients-pts-receiving-belatacept-ctla4ig/. Accessed June 7, 2020.
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