Excellent one year graft and patient survival with comparable rejection and infection rates in ABO-incompatible kidney transplants with alemtuzumab induction compared to ABO-compatible recipients with basiliximab induction

H. Bouwsma, E.E. Nijgh, A.T.M. Bisschop - van Leijden, M.J.K. Mallat, M.E.J. Reinders, J.W. de Fijter, A.P.J. de Vries

Friday 16 march 2018

11:00 - 11:10h at Willem Burger Zaal

Categories: Clinical, Session (parallel)

Parallel session: Parallel session 13: Clinical

Introduction

ABO-incompatible kidney transplantation (ABO-i) is a good option for kidney transplantation with documented one-year graft survival above 95%. A number of induction regimes are used worldwide, most notably with rituximab as primary agent. At our center we have used alemtuzumab as induction for ABO-i since 2011. We compared our patient survival, graft survival, rejection rate and incidence of CMV, EBV, and BK viremia with our ABO-compatible kidney transplantation (ABO-c) patients with basiliximab induction.

Methods

We compared patient survival, graft survival (death censored), rejection (biopsy proven or rejection treatment without biopsy) and CMV, EBV and BK viremia at one year follow-up for all ABO-i with alemtuzumab induction to all living ABO-c with basiliximab induction transplanted at our center from January 1, 2011 to November 17, 2016. ABO-i preconditioning was as follows: alemtuzumab 30 mg s.c. was administered 30-40 days prior to transplantation. Recipients with high pre-transplant titers (≥ 128 and later 250) also underwent 1 cycle of bortezomib 1.3 mg/m² (i.v. or s.c.) followed by plasmapheresis to facilitate titer reduction. Two weeks before transplantation triple immunosuppression was started (CNI, mycophenolic acid, steroids). Pre-operatively antigen-specific adsorption or plasmapheresis was performed to achieve a pre-transplant titer ≤ 8. One day before surgery additional alemtuzumab (15 mg s.c.) and IVIG 0.5 g/kg was administrated. Post-transplantation one antigen-specific adsorption was performed. If titers increased by more than two titer steps in the first two weeks post-transplantation antigen-specific adsorption was repeated. Our ABO-c patients received basiliximab 20 mg i.v. on the day of transplantation and on day 4 post-transplantation in combination with similar immunosuppression.

Results

A total 55 ABO-i’s and 273 ABO-c’s were performed in this period. Death censored graft survival was 98.1% in the ABO-i and 98.5% (p=ns) in the ABO-c group. Patient survival was 96.3% vs 98.9% (p=ns). Rejection rate in the first 6 weeks was 14.5% vs 13.9%, in the first year 18.1% vs 18.3%. CMV viremia (log>2) occurred more often in the ABO-i group than in the ABO-c group (21.8% vs 8.7%), BK viremia was similar (21.8% vs 18.3%), EBV viremia (log>2) was low in both groups: 0 vs 1.8%.

Conclusion

Excellent one-year results are achieved with alemtuzumab induction in ABO-i and are comparable to low-risk ABO-c with basiliximab induction.