Rituximab Desensitization (DES) and Alemtuzumab Induction Significantly Reduced EBV Viremia and Post-Transplant Lymphoproliferative Disorder (PTLD) in HLA-Sensitized (HS) Kidney Transplant Patients.
1Transplant Immunology Laboratory and Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA
2Biostatistics Core, Cedars-Sinai Medical Center/UCLA School of Medicine, Los Angeles, CA
Meeting: 2017 American Transplant Congress
Abstract number: 556
Keywords: Epstein-Barr virus (EBV), Immunosuppression, Kidney transplantation, Post-transplant lymphoproliferative disorder (PTLD)
Session Information
Session Time: 4:30pm-6:00pm
Presentation Time: 5:30pm-5:42pm
Location: E271b
Background: PTLD is a serious complication in KTx pts and is usually associated with EBV infection. Recent studies showed that rituximab treatment prior to Tx reduced EBV viremia and risk for PTLD, likely via elimination of B cells which are EBV reservoirs. DES with IVIg+rituximab followed by KTx with ATZ induction increased successful Tx rates in HS pts. Here, we investigate if rituximab used for DES and ATZ induction reduces EBV viremia and PTLD by comparing DES vs. non-DES pts. Methods: The rate of EBV viremia with >30 copies/PCR and PTLD up to average 24M post-Tx were compared in 368 DES (13 EBV sero[-]) vs. 524 non-DES (33 sero[-]) adult pts. DES pts received IVIG (2g/kg on D0 & D30) + rituximab (1g on D15) received ATZ (30 mg SQ x1) induction when transplanted. Non-DES pts received anti-thymocyte globulin or anti-CD25 induction. Both groups received standard triple immunosuppression maintenance. All received CMV-prophylaxis. Results: EBV viremia was significantly lower in DES pts (3% vs. 11%, p=0.001). No pt developed PTLD in either group. When the results were compared separately by EBV serology at Tx, overall, sero(-) non-DES pts showed least freedom from EBV viremia (p<0.001). In non-DES pts, the EBV viremia rate was significantly higher in sero(-) vs. sero(+) pts (27% vs. 11%, p<0.001), while significant differences were not seen in DES pts, although there was a trend (8% vs. 3%, p=0.2).Among EBV sero(+) pts, the EBV viremia rate was significantly lower in DES pts (3% vs. 11%, p<0.01). The EBV viremia was also lower in sero(-) DES pts (8% vs. 27%, p=0.21), but this was not statistically significant. Conclusions: IVIg+rituximab DES combined with ATZ induction with triple immunosuppression maintenance does not increase the risk for EBV and PTLD under anti-viral surveillance with anti-viral prophylaxis for 6M post-Tx and EBV-PCR monitoring for early detection and early intervention. Elimination of B cells and EBV reservoirs, by rituximab and ATZ may reduce or prevent the reactivation of latent EBV and/or primary infection.
CITATION INFORMATION: Shin B.-H, Ge S, Mirocha J, Thomas D, Rodriguez E, Chao C, Galera O, Vo A, Choi J, Peng A, Kahwaji J, Jordan S, Toyoda M. Rituximab Desensitization (DES) and Alemtuzumab Induction Significantly Reduced EBV Viremia and Post-Transplant Lymphoproliferative Disorder (PTLD) in HLA-Sensitized (HS) Kidney Transplant Patients. Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Shin B-H, Ge S, Mirocha J, Thomas D, Rodriguez E, Chao C, Galera O, Vo A, Choi J, Peng A, Kahwaji J, Jordan S, Toyoda M. Rituximab Desensitization (DES) and Alemtuzumab Induction Significantly Reduced EBV Viremia and Post-Transplant Lymphoproliferative Disorder (PTLD) in HLA-Sensitized (HS) Kidney Transplant Patients. [abstract]. Am J Transplant. 2017; 17 (suppl 3). https://atcmeetingabstracts.com/abstract/rituximab-desensitization-des-and-alemtuzumab-induction-significantly-reduced-ebv-viremia-and-post-transplant-lymphoproliferative-disorder-ptld-in-hla-sensitized-hs-kidney-transplant-patients/. Accessed November 25, 2024.« Back to 2017 American Transplant Congress