Introduction: Viral infections represent significant infectious complications post- kidney transplant which may be increased with desensitization. CMV, EBV and BKV infections are the most prevalent. Desensitization with IVIg and rituximab with/without plasma exchange followed by kidney transplantation with alemtuzumab increases transplant rates in HS patients but may represent an increased risk for viral infections due to lymphocyte depletion. Recent data suggests that reduced dose tacrolimus + everolimus (tac+ev) may increase Viral-Tc responses, limiting risk for viral infections. Here, we report on the post-transplant viral infection status and Viral-Tc in 19 HS patients treated with tac+ev compared to 372 HS patients maintained on (tac+mmf). Methods: Viremia was monitored by real time-PCR in 19 tac+ev and 372 tac+mmf patients. Viral-Tc levels for CMV and EBV were monitored in all 19 tac+ev and 30 tac+mmf using intracellular IFNγ flow cytometry analysis. Results: CMV (5% [1/19] vs 14% [50/372], p=0.3) and EBV (5% [1/19] vs. 6% [21/372], p=0.9) viremia were similar in tac+ev and tac+mmf patients. However, BK viremia was significantly higher in tac+ev patients (32% [6/19] vs. 14% [51/372], p=0.03). No patients developed PTLD. Viral-Tc for CMV & EBV were eliminated by induction, but rebounded 1-3M post-transplant in both tac+ev and tac+mmf patients, and the results were similar. Data are shown below . Here, pre-transplant Viral-Tc levels (CMV & EBV) are + before transplant and decrease after induction therapy. Viral-Tc activity returns to acceptable levels within 1-3M. Conclusions. Desensitization with alemtuzumab eliminates Viral-Tc responses but recovery is seen in 1-3M post-transplant. Everolimus + reduced dose tac showed similar Viral-Tc responses to standard dose tac+mmf in HS patients and was associated with an increase in BK viremia compared to the tac+mmf group.

CITATION INFORMATION: Ge S., Chu M., Karasyov A., Lovato D., Kahwaji J., Vo A., Choi J., Louie S., Jordan S., Toyoda M. Viral-Specific Cytotoxic T-Cell (Viral-Tc) Responses in Highly-HLA-Sensitized Patients (HS) Maintained on Tacrolimus and Everolimus Post-HLAi Kidney Transplant Am J Transplant. 2017;17 (suppl 3).

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