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Kidney Week

Abstract: PO2545

Prophylactic Use of Eculizumab and Graft Loss in Kidney Transplant Recipients due to Hemolytic Uremic Syndrome in the United States

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Plasse, Richard A., Walter Reed National Military Medical Center, Bethesda, Maryland, United States
  • Olson, Stephen W., Walter Reed National Military Medical Center, Bethesda, Maryland, United States
  • Yuan, Christina M., Walter Reed National Military Medical Center, Bethesda, Maryland, United States
  • Agodoa, Lawrence, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, United States
  • Abbott, Kevin C., National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, United States
  • Nee, Robert, Walter Reed National Military Medical Center, Bethesda, Maryland, United States
Background

Among kidney transplant recipients (KTRs) with end-stage kidney disease (ESKD) due to hemolytic uremic syndrome (HUS), recurrence is associated with poor allograft outcomes. We examined the prophylactic use of eculizumab, a monocloncal antibody that binds complement protein C5, and graft loss among HUS KTRs.

Methods

We conducted a retrospective cohort study using the United States Renal Data System. Out of 123,624 ESKD patients transplanted between January 1, 2008 and June 1, 2016, we identified 348 (0.28%) patients who had HUS as the primary cause of ESKD. We then linked these HUS patients to datasets containing the Healthcare Common Procedure Coding System (HCPCS) code for eculizumab infusion. We calculated crude incidence rates of overall graft loss and death-censored graft loss and conducted exact logistic regression, adjusted for recipient age and sex. Patients who received eculizumab prior to or within 30 days of transplant represented the exposure group.

Results

Our final study cohort included 335 HUS KTRs (23 received eculizumab, 312 did not). There were no significant differences in baseline demographic and clinical characteristics between the eculizumab vs. non-eculizumab group. For those who received eculizumab, the median number of infusions per patient was 42 (IQR 16, 66). The median payment amount per patient was $706,518 (IQR 241,237, 1,306,453). Eculizumab was discontinued in 9 out of 23 patients (39%), after a median prophylactic duration of 329 days (IQR 127, 791). As shown in the Table, the eculizumab group had no graft loss vs. 20% in the non-eculizumab group, with an adjusted odds ratio of 0.13.

Conclusion

Prophylactic use of eculizumab in HUS KTRs was significantly associated with a lower risk of graft loss. Given the high cost of eculizumab, randomized controlled trials are much-needed to guide prophylactic strategies to prevent graft loss.