Abstract: SA-PO508

Low Dose Rituximab and Thymoglobulin Induction in a Steroid Free Protocol Involving Protocol Biopsies Improves Patient and Graft Survival at 11 Years after Kidney Transplantation

Session Information

Category: Transplantation

  • 1702 Transplantation: Clinical and Translational

Author

  • Pathak, Vivek, Kovai Medical Center and Hospitals, Coimbatore, Tamilnadu, India
Background

The purpose of this study is to document long term patient and graft survival in a steroid free regime with a different induction protocol.

Methods

1069 patients, who underwent renal transplantation at our institute in eleven years since July 2005 till Jan 2017 were studied. Thymoglobulin was used for induction at a dose of 1.5mg/kgm 3 doses in the first 5 days.Rituximab 200 mg was given to those patients who were considered to be at high risk for rejection and approximately 60 to 65% of the cohort received it. Maintenance immunosuppression was Tacrolimus and Mycophenolate mofetil. Prednisolone was rapidly discontinued by fifth post operative day. All patients underwent protocol biopsies at 3 months,1 year, 5 years and 10 years indicated biopsies were done whenever required.

Results

The Patient and graft survival rates at 11 years were 92% and 85.4 % respectively.Biopsy proven acute rejection free graft survival was 78.1% at 11 years including subclinical rejections. The cumulative incidence of graft loss was 8.07%. The incidence of death was 5.3%. This is an improvement over the data published by Rizarri et al(CJASN 2012) where patient and graft survival rates were 70% and 61% repsectively at 10 years. The OPTN data in AJT December 2016 showed all cause graft failure >35% at 10 years whereas our all cause graft failure is 14.6% at 11 years. 79.07% patients were prednisolone free at 11 years.

Conclusion

The reasons for the improved patient and graft survival in our study in comparison to published literature could have been the addition of low dose pre-operative Rituximab, steroid withdrawal and aggressive cardiovascular screening resulting in low post transplant mortality due to ischemic heart disease, decreased incidence of BK virus induced graft loss , reduced death due to malignancy and reduction in fatal infections.