Abstract: SA-PO690
Outcomes Using Alemtuzumab Induction in Pediatric Kidney Transplant Recipients
Session Information
- Pediatric Nephrology - 2
October 26, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Pediatric Nephrology
- 1900 Pediatric Nephrology
Authors
- Zhang, Yifeng, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, United States
- Kumar, Juhi, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, United States
Background
No standard guidelines for induction immunosuppression exist in pediatric kidney transplant and the choice is usually institution specific. Alemtuzumab (Campath) is a humanized monoclonal antibody that binds to the CD-52 membrane glycoprotein and causes profound depletion of T and B lymphocytes. Recent review of the NAPRTCS Registry showed that only 17.5% of patients received Alemtuzumab, compared to 48.5% thymoglobulin and 30.1% Basiliximab. It is the least used agent with minimal data on its longitudinal effects. Alemtuzumab has been associated with the development of de novo donor specific antibodies (DSAs) which has been shown to increase risk for allograft loss. Our center uses one dose of Alemtuzumab as induction with tacrolimus and mycophenolate mofetil maintenance immunosuppression. Aim of the study is to review our institution’s transplant outcomes with Alemtuzumab induction.
Methods
We did a retrospective chart review of 170 kidney transplant patients, aged 2 to 26 years old, transplanted between January 2010 to December 2023 who received Alemtuzumab as induction therapy. We examined incidence of viremia (CMV, BKV, EBV), BK viruria, DSAs, acute rejections, and patient and allograft survival rates.
Results
Median age at transplant was 12 years, (IQR 6-23). 60% of the patients were male. 50% received a deceased donor transplant. Incidence of viremia 6 months and 1 year post transplant for CMV was 3.6% and 2%, EBV 23% and 28%, BKV was 16% and 14%, and BK viruria was 31.9% and 31.2%, respectively. Incidence of Class II DSAs was 2% at 6 months, 3.4% at 1 year, 6.9% at 3 years, and 7.7% at 5 years post-transplant. Incidence of rejection at 6 months and 1 year post-transplant was 5.8% and 8.3%, respectively. Graft survival was 99.4% at 1 year, 94.7% at 3 years, and 93.5% at 5 years post-transplant. Patient survival was 96.4% and graft survival was 91.1% over the study period duration.
Conclusion
Alemtuzumab is a reasonable option for induction immunosuppression given its ease of administration with outcomes that are comparable to those reported for other induction agents in the literature.