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Kidney Week

Abstract: SA-PO016

Is More Intensive Induction Immunosuppression Therapy for Highly Sensitized Kidney Transplant Recipients Better?

Session Information

Category: Transplantation

  • 1802 Transplantation: Clinical

Authors

  • Mohamadou, Inna, Urgences Néphrologiques et Transplantation rénale. Hôpital Tenon. Assistance Publique Hopitaux de Paris, Paris, France
  • Matignon, Marie, Nephrology and transplantation department, Mondor Hospital, Creteil, France
  • Malard, Stephanie, Saint Louis Hospital APHP, Paris, France
  • Buob, David, Tenon Hospital, Paris, France
  • Grimbert, Philippe, Nephrology and transplantation department, Mondor Hospital, Creteil, France
  • Moktefi, Anissa, AP- HP, Hopital Henri Mondor, Creteil, France
  • Rondeau, Eric, Urgences Néphrologiques et Transplantation rénale. Hôpital Tenon. Assistance Publique Hopitaux de Paris, Paris, France
  • Luque, Yosu, Urgences Néphrologiques et Transplantation rénale. Hôpital Tenon. Assistance Publique Hopitaux de Paris, Paris, France
Background

Induction immunosuppression for highly sensitized kidney recipients varies, in particular the use of plasma exchanges (PE) and rituximab following transplantation to prevent antibody-mediated rejection (ABMR) and increase graft survival. We compared two induction strategies for patients undergoing kidney transplantation with a high level (MFI>3000) of pre-formed donor-specific antibody (DSA).

Methods

Our retrospective study included 45 kidney transplant recipients in two French centers, transplanted between 2012 and 2017. All patients had at least one pre-formed DSA (MFI > 3000) within 6 months before transplantation. All patients received anti-thymocyte globulin, a calcineurin inhibitor, mycophenolate mofetil and steroids on the day of transplantation. 22 of these 45 patients also received 5 PE and one rituximab dose (group A), whereas the remaining 23 patients did not (group B). Patients were followed for 1 to 6 years after transplantation.

Results

Comparing group A to group B, recipients’ age (48±14 vs. 47±12 years), donors’ age (54±16 vs. 57±12 years), cold ischemia time (16±6 vs. 19±7 hours) and MFI of the immunodominant DSA (8735±4192 vs. 10106± 6015) were similar (p=ns for all).

There was no overall difference in the rate of biopsy-proven acute rejection at 1 year post-transplantation (n=9, 41% in group A vs. n=7, 30% in group B). ABMR occurred in n=6 vs. n=7 patients, and T-cell mediated rejection was observed in n=3 vs. n=0 patients, respectively in groups A and B. There was no difference in graft survival rate at 1 year post-transplant (91% in group A vs. 83% in group B, p=ns). Finally, the incidence of infectious, anaphylactic, thrombotic or hemorrhagic events was similar between the two groups.

Conclusion

Our study suggests that an intensive induction immunosuppressive therapy using PE and rituximab during early post-transplantation period does not decrease ABMR incidence or improve 1-year graft survival in highly sensitized recipients. An effect of PE on anti-thymocyte globulin pharmacokinetics could not be excluded.