1088. Infectious Complications According to Recipient Age and Ethnicity in a Randomized Prospective Trial of Depleting Antibody Induction in Kidney and Pancreas Transplantation
Session: Poster Abstract Session: Infections After Solid Organ Transplants
Saturday, October 22, 2011
Room: Poster Hall B1
Handouts
  • IDSA 2011 CvT IC poster.pdf (441.7 kB)
  • Background: Increased risk of infectious complications (ICs) after kidney (K) and pancreas (P) transplant (Tx) is a major concern when using lymphocyte depleting antibody induction agents such as alemtuzumab (Alem) and rabbit anti-thymocyte globulin (rATG).

    Methods: We conducted a prospective, randomized trial comparing single dose Alem (30 mg) to alternate day rATG (1.5 mg/kg) induction in adult KTx and PTx patients (pts). Maintenance therapy was tacrolimus, mycophenolic acid, and risk stratification to determine early steroid elimination. Infection prophylaxis was given for fungal (1 month KTx; 2 month PTx), pneumocystis (12 month), and CMV (3 months; 6 months for primary CMV exposure). ICs were graded according to NIH Clinical Toxicity Criteria (CTCAE version 3.0).

    Results: Over a 3.5 year period (median follow-up 24 months), 222 pts were enrolled (113 randomized to Alem,109 to rATG induction). Demographics were similar between groups, 70 (31.5%) were African-American (36 received Alem), and 52 pts (23%) were age >60 years (27 received Alem). Overall pt, KTx, and PTx survival rates were 95%, 90%, and 85%, respectively, and were comparable between induction groups (p=NS). Incidence of biopsy proven acute rejection (BPAR) was lower in the Alem (16%) vs rATG group (26%, p= 0.03); the presence of BPAR increased the overall risk of ICs from 41% to 72% (p<.001). Of 113 Alem pts, 61 (54%) developed ICs compared to 81 (74%, p=.002) in the rATG group. There were no significant differences in the incidence or severity of ICs according to recipient ethnicity either in the Alem or rATG induction groups. However, the incidence of viral and fungal infections was higher in Caucasians compared to AAs receiving Alem (p=0.02) but not rATG. In pts >60 years, there were no differences in the number of pts with infection or in the rate of hospitalization for infection compared to pts <60 years. In addition, the severity of ICs in older vs younger pts was similar regardless of recipient ethnicity.    

    Conclusion: Alem is associated with a lower incidence of BPAR and ICs compared to rATG induction regardless of pt age or ethnicity.


    Subject Category: O. Transplant infectious diseases

    Robert Stratta, MD, William Doares, PharmD, Alan Farney, MD, PhD, Jeffrey Rogers, MD and Lois Hart, BS, Wake Forest Univ. School of Medicine, Winston-Salem, NC

    Disclosures:

    R. Stratta, None

    W. Doares, None

    A. Farney, None

    J. Rogers, None

    L. Hart, None

    Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.