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Kidney Week

Abstract: PO2456

Induction with Alemtuzumab and Thymoglobulin in Kidney Transplant and the Risks of Leukopenia, Cytomegalovirus Infection, and BK Virus Nephropathy

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Zebi, Ali Mohammed, Penn State College of Medicine, Hershey, Pennsylvania, United States
  • Ghahramani, Aria, Penn State College of Medicine, Hershey, Pennsylvania, United States
  • Dauleh, Mujahed Maher Issa, Penn State College of Medicine, Hershey, Pennsylvania, United States
  • Ghahramani, Nasrollah, Penn State College of Medicine, Hershey, Pennsylvania, United States
Background

Induction immunosuppressive therapy at the time of kidney transplantation reduces the risk of allograft rejection and improves graft outcomes. We compared the association between induction with thymoglobulin and alemtuzumab on the risks of leukopenia, CMV infection, and BK virus nephropathy.

Methods

We used TriNetX, a global federated research network that provides access to statistics on the electronic medical record (EMR). The Penn State Health TriNetX searchable database allows the analysis of approximately 1.7 million Penn State Health patient observations dating back to 1997. We analyzed the EMR of 1070 adult patients who had undergone kidney transplant between 1997 and May 10, 2020 (mean age: 60 ± 17; Male: 63%; White: 81%; Hispanic or Latino: 8%). We created two cohorts based on induction with either thymoglobulin or alemtuzumab. We compared the rates of leukopenia, CMV infection and BK virus nephropathy between the two cohorts. We calculated the relative risk (RR) and the 95% confidence interval (CI) for each outcome in the thymoglobulin group compared with the alemtuzumab group. Analyses were done in the TriNetX “analytics” network using the browser-based real-time analytics features.

Results

Study cohorts included 220 patients (mean age: 57 ± 15) in the thymoglobulin group, and 160 patients (mean age: 54 ± 19) in the alemtuzumab group. Leukopenia occurred in 50 patients in the thymoglobulin group and in 70 patients in the alemtuzumab group (RR: 0.52; CI: 0.39 to 0.70; p<0.0001). CMV infection occurred in 40 patients in the thymoglobulin group and in 20 patients in the alemtuzumab induction group (RR: 1.45; CI: 0.89 to 2.39; p = 0.14). BK virus nephropathy occurred in 20 patients in the thymoglobulin group and in 20 patients in the alemtuzumab group (RR: 0.72; CI: 0.41 to 1.31; p = 0.29).

Conclusion

Induction therapy with thymoglobulin is associated with a lower risk of leukopenia compared with alemtuzumab induction. The risks of CMV infection and BK virus nephropathy are not statistically different in the two induction therapies.