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Incidence of Viral Infections in HLA-Sensitized Patients (HS Pts) Desensitized with IVIG + Rituximab (DES) Compared to Non-HS Pts Receiving Standard Immunosuppression.

S. Jordan, J. Choi, B. Shin, J. Kahwaji, S. Ge, D. Thomas, A. Vo, O. Galera, R. Villicana, A. Peng, M. Toyoda.

Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA.

Meeting: 2016 American Transplant Congress

Abstract number: A106

Keywords: Highly-sensitized, Viral therapy

Session Information

Session Name: Poster Session A: Kidney Desensitization

Session Type: Poster Session

Date: Saturday, June 11, 2016

Session Time: 5:30pm-7:30pm

 Presentation Time: 5:30pm-7:30pm

Location: Halls C&D

Introduction: HS pts (PRA>50%, DSA+ at transplant) who are transplanted without DES represent a significant risk for antibody-mediated rejection. Prior to transplantation, HS pts require DES with IVIG+Rituximab +/- PLEX and post-transplant T-cell depletion with Alemtuzmab. Here, we examined the risk for common post-transplant viral infections compared to normal low-risk non-HS pts. Methods: Pts who were transplanted from 2007 to present (413 HS vs. 598 non-HS) were assessed. HS pts received DES with IVIG (2g/kg, x2) + rituximab (1gm, x1), and Alemtuzmab 30 mg SQ x1 at transplant. Non-HS pts received Thymoglobulin or anti-CD25 at transplant with both groups being maintained on standard CNI-based immunosuppression. All received CMV-prophylaxis. Frequent CMV, EBV & BKV-PCR monitoring was performed post-transplant. The incidence of PTLD was also noted. Results: The results are shown in the Table. Briefly, the incidence of CMV-PCR(+) was significantly greater in Non-HS pts (19% vs. 14%, p=0.050). EBV-PCR(+) was also significantly greater in Non-HS pts (10% vs. 5%, p=0.003). The incidence of BKV-PCR(+) was similar in both groups. No pt in either group developed PTLD. Conclusions: Desensitized HS pts before incompatible transplantation are at lower risk for CMV and EBV-PCR(+) post-transplant compared to normal Non-HS pts. Elimination of B-cells by rituximab might reduce the possibility of reactivation of latent infection in EBV and CMV infected B-cells. In addition, the use of IVIG in this protocol likely has a beneficial effect in preventing or modulating viral infections. We conclude that DES does not increase the risk for viral infections post-transplant.

 

HS

Non-HS

p value

Total Patients

413

598

 

Age

49.2±12.9

51.5±14.1

0.008

Follow-up M post-Tx

22.4±20.4

23.1±20.1

0.589

       

CMV-PCR >5 copies/PCR, n (%)

98 (23.7)

162 (27.1)

0.229

CMV-PCR >30 copies/PCR, n (%)

58 (14.3)

112 (18.7)

0.050

       

EBV-PCR >5 copies/PCR, n (%)

20 (4.8)

60 (10.0)

0.003

EBV-PCR >30 copies/PCR, n (%)

9 (2.2)

24 (4.0)

0.107

       

BKV-PCR >250 copies/ml, n (%)

63 (15.3)

82 (13.7)

0.492

BKV-PCR >1500 copies/ml, n (%)

36 (8.7)

61 (10.2)

0.431

CITATION INFORMATION: Jordan S, Choi J, Shin B, Kahwaji J, Ge S, Thomas D, Vo A, Galera O, Villicana R, Peng A, Toyoda M. Incidence of Viral Infections in HLA-Sensitized Patients (HS Pts) Desensitized with IVIG + Rituximab (DES) Compared to Non-HS Pts Receiving Standard Immunosuppression. Am J Transplant. 2016;16 (suppl 3).

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To cite this abstract in AMA style:

Jordan S, Choi J, Shin B, Kahwaji J, Ge S, Thomas D, Vo A, Galera O, Villicana R, Peng A, Toyoda M. Incidence of Viral Infections in HLA-Sensitized Patients (HS Pts) Desensitized with IVIG + Rituximab (DES) Compared to Non-HS Pts Receiving Standard Immunosuppression. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/incidence-of-viral-infections-in-hla-sensitized-patients-hs-pts-desensitized-with-ivig-rituximab-des-compared-to-non-hs-pts-receiving-standard-immunosuppression/. Accessed May 9, 2025.

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