Impact of Prospective Monitoring for Donor Specific Antibodies on Renal Transplant Outcomes with Alemtuzumab Induction

V. Saini, V. Mudunuri, S. Cohn, G. Reddy, V. Raofi, L. Rocher, A. Koffron, R. Parasuraman, D. Samarapungavan

MultiOrgan Transplant Program, William Beaumont Hospital, Royal Oak, MI

Meeting: 2013 American Transplant Congress

Abstract number: C1352

Alemtuzumab (AL) induction has been associated with an excess of antibody-mediated rejection (AMR). We initiated a steroid-free AL protocol in August 2009 with prospective monitoring for de-novo donor-specific antibody (DSA). We compare outcomes of induction with AL (gr1), basiliximab (gr2) or Thymoglobulin® (gr3) in a contemporaneous cohort – Aug.’09 to Dec.’11; with a historical cohort induced with either BM or ATG (gr4) but with only ad hoc DSA monitoring – Jan.’08-Jul.’09.

Methods: This is a retrospective analysis of 232 renal transplant patients (Pt) from 2008-11. High risk Pt for immunosuppression-related complications (elderly, those with viral hepatitis, malignancy or chronic steroid therapy) were in gr2. Pt at high-risk of ATN or PRA>90% were in gr3. Pt with DSA +ve/CXM –ve, or CXM +ve/DSA -ve recieved AL. Pt who developed de novo DSA were maintained on tacrolimus levels 8-10ng/mL, mycophenolic acid (MPA) level > 2.0mcg/mL & targeted pre-emptive B cell therapy for high-titered DSA. We managed neutropenia with Neupogen. We compared the following outcome measures between the groups: acute cellular rejection (ACR), AMR, de novo DSA and 1 year Pt & graft survival.

Results: The median follow-up for AL was 14.5months (range 33-1197days). Gr1 had a higher incidence of de novo DSA compared to gr2 but was similar to gr3 & gr4. The overall incidence of ACR, AMR, Pt & graft loss was not significantly different between the groups. The subgroup of Pt in gr1 who were DSA +ve/CXM –ve or CXM+ve/DSA-ve did not develop additional DSA. As previously reported, AL induction is associated with a longer interval to development of DSA & ACR.


	gr1(n=41)	gr2(n=55)	gr3(n=32)	gr4(n=104)	p †
ACR	4(10%)	8(15%)	6(19%)	21(20%)	ns
AMR	2(5%)	0	1(3%)	5(5%)	ns
de novo DSA	13(32%)*	6(11%)*	9(28%)	20(19%)	<0.05*
Mortality-1 year	3(7%)	2(4%)	0	2(2%)	ns
Graft loss-1 year	2(5%)	2(4%)	3(9%)	4(4%)	ns
Days to ACR	215±169*	86±73*	116±152*	149±181*	<0.05*
Days to DSA	147±160*	64±56*	64±88*	119±170	<0.05*

† gr1 vs other groups

Conclusion: Prospective monitoring for DSA with pre-emptive intervention may abrogate the risk of AMR & graft loss after AL induction. Further follow-up is required to determine the potential impact of these DSA on long-term Pt & graft survival.

To cite this abstract in AMA style:

Saini V, Mudunuri V, Cohn S, Reddy G, Raofi V, Rocher L, Koffron A, Parasuraman R, Samarapungavan D. Impact of Prospective Monitoring for Donor Specific Antibodies on Renal Transplant Outcomes with Alemtuzumab Induction [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/impact-of-prospective-monitoring-for-donor-specific-antibodies-on-renal-transplant-outcomes-with-alemtuzumab-induction/. Accessed November 22, 2024.

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