Haematological Autoimmune Disorders Associated with Alemtuzumab Induction in Renal and Simultaneous Pancreas and Kidney Recipients
1Renal and Transplant Centre, Imperial College NHS Trust, London, United Kingdom
2Department of Haematology, Imperial College NHS Trust, London, United Kingdom.
Meeting: 2018 American Transplant Congress
Abstract number: A142
Keywords: Adverse effects, Thrombocytopenia
Session Information
Session Name: Poster Session A: Kidney Complications: Late Graft Failure
Session Type: Poster Session
Date: Saturday, June 2, 2018
Session Time: 5:30pm-7:30pm
Presentation Time: 5:30pm-7:30pm
Location: Hall 4EF
Introduction
Haematological Autoimmune Disorders (HAD) have been associated with Alemtuzumab (Az); namely immune thrombocytopenia (ITP), autoimmune haemolytic anaemia (AIHA), Evans syndrome (ES) and Red Cell Aplasia (RCA). We describe the largest cohort to date of patients developing HAD associated with a single dose of alemtuzumab induction for RT or SPK.
Methods:
Records of 1541 RT or SPK recipients with Az-induction during 2005-2017 were retrospectively studied for the occurrence of HAD, excluding recipients with < 6m follow-up. Patients received a single dose of Az perioperatively, followed by tacrolimus monotherapy with a steroid sparing protocol. MMF and steroids were added only for biopsy-proven rejection. Secondary ITP/AIHA and PTLD were excluded.
Results:
39 of 1541 patients (2.5%) developed HAD over a mean follow-up of 5.1±3.2 years. 24/39 developed ITP, 9/40 AIHA, 3/40 ES, 2 patients had ITP and AIHA and 1 patient had RCA and ITP at different time points. Mean time from Az exposure to HAD diagnosis was 34.1±25.8m (median 29m). Most patients were asymptomatic at diagnosis. Prednisolone+/-IVIG was the first-line treatment, followed by Rituximab for AIHA and Thrombopoeitin-receptor-agonists for ITP. 34/39 achieved complete remission (CR) and 1 patient remains in partial remission (PR). Recurrence was observed in 9/34 patients who responded to a 2nd cycle of treatment. Mean time-to-recurrence was 11.7±8.5m. 2 grafts were lost peri-HAD diagnosis due to infection and FSGS recurrence respectively. 3/39 (7.7%) patients died due to complications associated with HAD before this consequence of Az induction was fully recognised.
Conclusion:
HAD post Az induction are characterized by asymptomatic presentation, delayed onset post exposure and responsiveness to treatment. Although the incidence is low, they are associated with significant morbidity and mortality. Increased awareness, early diagnosis and prompt treatment are essential for improved outcome.
CITATION INFORMATION: Kousios A., Charif R., Atta M., Luqmani A., Cooper N., Taube D. Haematological Autoimmune Disorders Associated with Alemtuzumab Induction in Renal and Simultaneous Pancreas and Kidney Recipients Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Kousios A, Charif R, Atta M, Luqmani A, Cooper N, Taube D. Haematological Autoimmune Disorders Associated with Alemtuzumab Induction in Renal and Simultaneous Pancreas and Kidney Recipients [abstract]. https://atcmeetingabstracts.com/abstract/haematological-autoimmune-disorders-associated-with-alemtuzumab-induction-in-renal-and-simultaneous-pancreas-and-kidney-recipients/. Accessed June 2, 2025.« Back to 2018 American Transplant Congress