Session Time: 5:30pm-7:30pm
Presentation Time: 5:30pm-7:30pm
Location: Halls C&D
- Long Term Outcomes of Highly-HLA Sensitized (PRA>80%) (HS) Patients Receiving Desensitization with IVIG or IVIG + Rituximab: A Retrospective, Single-Center Analysis
- 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).
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.
Follow-up M post-Tx
CMV-PCR >5 copies/PCR, n (%)
CMV-PCR >30 copies/PCR, n (%)
EBV-PCR >5 copies/PCR, n (%)
EBV-PCR >30 copies/PCR, n (%)
BKV-PCR >250 copies/ml, n (%)
BKV-PCR >1500 copies/ml, n (%)
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).
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 March 31, 2020.
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