Background: Optimal induction for patients without pretransplant donor-specific antibodies (DSAs) is poorly defined. The goal of this study was to compare the incidence of de novo DSA (dnDSA) and graft outcomes between induction therapies in patients with a negative virtual crossmatch (VXM). Methods: A retrospective chart review was performed, identifying 782 patients with a negative VXM who underwent kidney transplantation at a single, high-volume institution between January 2013 and May 2017. Kaplan-Meier analysis was used to assess the incidence of dnDSA and allograft survival between induction therapies in this group. dnDSA is defined as the development of new post-transplant DSA, at any MFI level. Results: Induction therapy included alemtuzumab (N=87, 11%), basiliximab (N=522, 67%), and anti-thymocyte globulin (ATG; N=173, 22%). One-year graft survival was similar between groups (alemtuzumab, 100%; basiliximab, 98%; ATG, 99%). Incidence of acute rejection at 1 year was <2% and not different between the three groups. Alemtuzumab was associated with the highest incidence of dnDSA at 14%, compared with 5% and 8% in basiliximab and ATG groups, respectively, at 1 year (P=0.009). In multivariate regression analyses, alemtuzumab retained its significant association with a dnDSA HR of 2.5 (95% CI, 1.51 to 4.25; P=0.0004). Conclusions: In summary, alemtuzumab was associated with a higher rate of dnDSA development in patients with a negative VXM; however, this finding was not associated with rejection or graft failure.
Background: Optimal induction for patients without pretransplant donor-specific antibodies (DSAs) is poorly defined. The goal of this study was to compare the incidence of de novo DSA (dnDSA) and graft outcomes between induction therapies in patients with a negative virtual crossmatch (VXM). Methods: A retrospective chart review was performed, identifying 782 patients with a negative VXM who underwent kidney transplantation at a single, high-volume institution between January 2013 and May 2017. Kaplan-Meier analysis was used to assess the incidence of dnDSA and allograft survival between induction therapies in this group. dnDSA is defined as the development of new post-transplant DSA, at any MFI level. Results: Induction therapy included alemtuzumab (N=87, 11%), basiliximab (N=522, 67%), and anti-thymocyte globulin (ATG; N=173, 22%). One-year graft survival was similar between groups (alemtuzumab, 100%; basiliximab, 98%; ATG, 99%). Incidence of acute rejection at 1 year was <2% and not different between the three groups. Alemtuzumab was associated with the highest incidence of dnDSA at 14%, compared with 5% and 8% in basiliximab and ATG groups, respectively, at 1 year (P=0.009). In multivariate regression analyses, alemtuzumab retained its significant association with a dnDSA HR of 2.5 (95% CI, 1.51 to 4.25; P=0.0004). Conclusions: In summary, alemtuzumab was associated with a higher rate of dnDSA development in patients with a negative VXM; however, this finding was not associated with rejection or graft failure.
Authors: H Sollinger; B Kaplan; M D Pescovitz; B Philosophe; A Roza; K Brayman; K Somberg Journal: Transplantation Date: 2001-12-27 Impact factor: 4.939
Authors: William C Goggins; Manuel A Pascual; John A Powelson; Colm Magee; Nina Tolkoff-Rubin; Mary Lin Farrell; Dicken S C Ko; Winfred W Williams; Anil Chandraker; Francis L Delmonico; Hugh Auchincloss; A Benedict Cosimi Journal: Transplantation Date: 2003-09-15 Impact factor: 4.939
Authors: Yvon Lebranchu; Frank Bridoux; Matthias Büchler; Yannick Le Meur; Isabelle Etienne; Olivier Toupance; Bruno Hurault de Ligny; Guy Touchard; Bruno Moulin; Patrick Le Pogamp; Olivier Reigneau; Michel Guignard; Gérard Rifle Journal: Am J Transplant Date: 2002-01 Impact factor: 8.086
Authors: Judith E Worthington; Susan Martin; Dalia M Al-Husseini; Philip A Dyer; Robert W G Johnson Journal: Transplantation Date: 2003-04-15 Impact factor: 4.939
Authors: Sandesh Parajuli; Didier A Mandelbrot; Brenda Muth; Maha Mohamed; Neetika Garg; Fahad Aziz; Robert R Redfield; Weixiong Zhong; Brad C Astor; Arjang Djamali Journal: Transplant Direct Date: 2017-10-27