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Three-Year Outcomes of Highly-Sensitized Kidney Transplant Recipients Desensitized with Imlifidase (IdeS)

E. Huang1, J. Choi1, A. Vo1, A. Peng1, R. Najjar1, S. Sethi1, C. Kjellman2, L. Winstedt2, N. Ammerman1, S. C. Jordan1

1Cedars Sinai Medical Center, Los Angeles, CA, 2Hansa Medical, Lund, Sweden

Meeting: 2019 American Transplant Congress

Abstract number: 620

Keywords: Highly-sensitized, Kidney transplantation, Rejection

Session Information

Date: Wednesday, June 5, 2019

Session Name: Plenary Session IV

Session Time: 8:30am-10:00am

 Presentation Time: 8:30am-8:45am

Location: Veterans Auditorium

Related Abstracts
  • Anti-HLA IgM Antibodies Are Reduced in Highly-HLA Sensitized Patients Transplanted after Imlifidase (IdeS) Treatment
  • Experience with the Bacterial Enzyme IdeS (IgG Endopeptidase) for Desensitization of Highly-HLA Sensitized (HS) Kidney Allograft Recipients.

*Purpose: The HLA-incompatible (HLAi) barrier has been traversed using desensitization therapies with IVIg, rituximab and/or plasmapheresis, although antibody-mediated rejection (ABMR) continues to be observed in 25-42% cases and constitutes the primary cause of early graft loss. Imlifidase (IdeS) is an IgG endopeptidase which cleaves human IgG into Fc and F(ab)’2 fragments. Previous data (N Engl J Med 2017) demonstrated efficacy in rapidly desensitizing HLA sensitized patients, allowing successful kidney transplantation. Here, we report follow up data up to 3 years on patients transplanted after IdeS desensitization.

*Methods: Sixteen highly-sensitized kidney transplant recipients were desensitized with IdeS 0.24 mg/kg at transplant and alemtuzumab on post-operative day 4, IVIG 2 g/kg on day 7, and rituximab 375 mg/m2 on day 14. Follow up data on de novo and rebound DSA generation, death, graft loss, and eGFR were examined.

*Results: Twelve of 16 recipients had a positive flow crossmatch and 14/16 (88%) had DSA at the time of transplant (median sum MFI 8750, IQR: 3750-16250). No patients had DSA immediately following IdeS administration and DSA rebound out to 30 months was generally mild (fig 1). There were seven episodes of ABMR and 8 episodes of cell-mediated rejection (fig 2a). Two graft losses were observed over 31.9 person-years of follow-up, conferring an incidence rate of 6.3 graft losses/100 patient-years. Both graft losses were unrelated to IdeS and developed at 2.6 and 3.2 years after transplant. One death occurred ten months after transplant. The estimated GFR was 60.8 ml/min/1.73 m2 (95% CI: 44.2-77.4) at 1 year and 47.5 ml/min/1.73 m2 (30.3-64.8) at 3 years (fig 2b).

*Conclusions: IdeS given for desensitization facilitated deceased donor kidney transplantation in highly-sensitized, HLA-incompatible kidney recipients with excellent graft survival out to 3 years.

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To cite this abstract in AMA style:

Huang E, Choi J, Vo A, Peng A, Najjar R, Sethi S, Kjellman C, Winstedt L, Ammerman N, Jordan SC. Three-Year Outcomes of Highly-Sensitized Kidney Transplant Recipients Desensitized with Imlifidase (IdeS) [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/three-year-outcomes-of-highly-sensitized-kidney-transplant-recipients-desensitized-with-imlifidase-ides/. Accessed January 22, 2021.

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