Induction Therapy with Depleting Antibodies in Low Immunological Risk Renal Transplant Patients Treated with a Steroid Free Regimen – Comparison of Alemtuzumab vs. Antithymocyte Globulin.
1Division and Chair of Nephrology, A.O "Spedali Civili"
and University, Brescia, Italy
2Division and Chair of II Laboratory of Pathology, A.O "Spedali Civili"
and University, Brescia, Italy.
Meeting: 2016 American Transplant Congress
Abstract number: 518
Keywords: Immunosuppression, Induction therapy, Kidney transplantation, Rejection
Session Information
Date: Tuesday, June 14, 2016
Session Name: Concurrent Session: Kidney: Induction Therapy 2
Session Time: 4:30pm-6:00pm
Presentation Time: 4:42pm-4:54pm
Location: Room 312
Induction therapy with depleting antibodies reduces rejection rate and potentially improves efficacy of steroid free regimens after renal transplantation.
This prospective, single-centre, cohort study evaluated cumulative incidence of one-yr biopsy-proven acute rejection (BPAR) among 162 consecutive primary, non sensitized kidney transplant recipients who received either alemtuzumab (n=82) or rabbit-antithymocyte globulin (r-ATG) (n=82) induction, followed by tacrolimus and mTor-inhibitor (sirolimus or everolimus). Steroid was not used except in case of rejection. Protocol biopsies and HLA donor-specific antibodies (DSA) were obtained at 12 months from transplantation.
Alemtuzumab and r-ATG groups were similar in demographics, cause of ESRD, cold ischemia time, delayed graft function, HLA mismatch, CMV mismatch. The one-yr clinical BPAR rate was lower in alemtuzumab group (3.6% vs 19.5%, p=0.003) resulting in greater probability of being free from steroid at that time (93.9% vs 69.5%, p=0.002). Three-yr patient survival (97.6 % vs. 96.3%), graft survival (98.8% vs 97.5%), one-yr serum creatinine (1.5 ± 0.5 mg/dl), proteinuria (0.4 ± 0.7 gr/24h vs 0.4± 0.5 gr/24h), DSA rate (7.6% vs 7.7%) and CMV infection rate (20.7% vs 19.5%), were similar between the two induction groups. BK-viremia or BK virus nephritis were higher in alemtuzumab group, but not statistically significant (12.2% vs. 2.4%, p=0.06). Protocol biopsies, obtained 12.7±1.5 months on average, showed subclinical acute rejection in 11.8% vs 3.3% respectively (p=0.14). In most cases the BPAR were antibody mediated or mixed (92.9% vs 76.4%). At follow-up (6,4±2,1 yr vs. 2,6±1 yr ) chronic rejection rate was 11% vs 5.4% respectively.
In low immunological risk kidney transplant recipient on steroid-free immunosuppression, both alemtuzumab and rATG induction therapies were safe and effective. Alemtuzumab was associated with lower clinical acute rejection rate. The statistically nonsignificant trend to a higher incidence of one-yr subclinical acute rejection, humural rejection and BK-virus nephritis, observed after alemtuzumab induction, highlights the need for further studies.
CITATION INFORMATION: Bossini N, Sandrini S, Tardanico R, Valerio F, Setti G, Salviani C, Possenti S, Foini P, Marta E, Cancarini G. Induction Therapy with Depleting Antibodies in Low Immunological Risk Renal Transplant Patients Treated with a Steroid Free Regimen – Comparison of Alemtuzumab vs. Antithymocyte Globulin. Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:
Bossini N, Sandrini S, Tardanico R, Valerio F, Setti G, Salviani C, Possenti S, Foini P, Marta E, Cancarini G. Induction Therapy with Depleting Antibodies in Low Immunological Risk Renal Transplant Patients Treated with a Steroid Free Regimen – Comparison of Alemtuzumab vs. Antithymocyte Globulin. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/induction-therapy-with-depleting-antibodies-in-low-immunological-risk-renal-transplant-patients-treated-with-a-steroid-free-regimen-comparison-of-alemtuzumab-vs-antithymocyte-globulin/. Accessed March 23, 2019.« Back to 2016 American Transplant Congress