640 - Longitudinal Outcomes Using Alemtuzumab Induction in Pediatric Kidney Transplants
Sunday, April 27, 2025
8:30am – 10:45am HST
Publication Number: 640.5833
Yifeng Zhang, UPMC Childrens Hospital of Pittsburgh, Pittsburgh, PA, United States; Katherine Kurzinski, UPMC Childrens Hospital of Pittsburgh, Pittsburgh, PA, United States; Armando J. Ganoza, UPMC Childrens Hospital of Pittsburgh, PITTSBURGH, PA, United States; Juhi Kumar, UPMC Childrens Hospital of Pittsburgh, Pittsburgh, PA, United States
Pediatric Nephrology Fellow UPMC Childrens 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 18% of patients received Alemtuzumab, compared to 49% Thymoglobulin and 30% 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 (DSA) which has been shown to increase risk for allograft loss. Our center uses one dose of Alemtuzumab as induction and a primarily steroid free maintenance immunosuppression regimen with tacrolimus and mycophenolate mofetil. Objective: To review our institution’s transplant outcomes with Alemtuzumab induction. Design/Methods: Single center retrospective study of 170 patients, ages 2 to 26 years old, who received Alemtuzumab (single dose of 0.5 mg/kg/dose, max 30 mg) for their kidney transplant between 1/2010 to 12/2023 as induction immunosuppression. We examined incidence of acute rejections, DSA, viremia (CMV, BKV, EBV), BK viruria, and patient and allograft survival rates. Results: The median age at transplant was 12 years, (IQR 6-23 years). 60% of the patients were male. 50% received a deceased donor transplant. The median follow-up time was 4.96 years (IQR 2.9-7.6 years). Of the 118 patients (69%) who developed DSAs over the study period, 36.5% formed early DSAs (less than 1-year post-transplant) and 63.5% formed late DSAs. Cumulative incidence of antibody-mediated rejection and T-cell mediated rejection at 6 months, 1 year and 2 years post-transplant was 0.59%, 1.2%, and 5.3% and 7.6%, 13%, and 29%, respectively. Incidence of viremia 6 months and 1 year post transplant for CMV was 3.6% and 2%, EBV was 23% and 28%, BKV was 16% and 14%, and BK viruria was 31.9% and 31.2%, respectively. Unadjusted living donor graft survival was 97.6% at 5 years and 97% at 10 years post-transplant. Unadjusted deceased donor graft survival was 95.8% at 5 years and 94.1% at 10 years post-transplant. Patient survival was 98.8% and 96.4% at 5- and 10-years post-transplant.
Conclusion(s): 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.
