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Kidney Week

Abstract: SA-PO919

Outcome of Kidney Transplantation in Atypical Hemolytic Uremic Syndrome (aHUS): Eculizumab Prophylaxis vs. Rescue Therapy

Session Information

Category: Glomerular Diseases

  • 1402 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Duineveld, Caroline, Radboudumc, Nijmegen, Gelderland, Netherlands
  • Glover, Emily, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom
  • Bouwmeester, Romy N., Radboudumc, Nijmegen, Gelderland, Netherlands
  • Van De Kar, Nicole, Radboudumc, Nijmegen, Gelderland, Netherlands
  • Kavanagh, David, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom
  • Wetzels, Jack F., Radboudumc, Nijmegen, Gelderland, Netherlands
  • Sheerin, Neil S., Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom
Background

Prophylactic eculizumab therapy is advised in aHUS kidney transplant recipients in view of high risk of recurrence. However, historical recurrence rates may be overrated and early start of eculizumab therapy at relapse (“rescue”) may prevent graft loss. The efficacy, safety, and costs of different treatment strategies have not been compared in RCT’s. We performed a comparative cohort study, including patients from a previously described Dutch cohort (NL) treated with eculizumab rescue therapy [PMID 37069997] and a UK aHUS cohort using eculizumab prophylaxis [PMID 36413152].

Methods

NL: we selected all adult aHUS patients who received a kidney transplantation between 2010-2021 in the Radboudumc (n=30) and enriched this cohort with 8 patients who received rescue therapy in other centers. UK: all adult aHUS patients transplanted between 2013 and 2017 were included.

Results

We included 38 NL patients (29 F, median age 45y, range 22-68) and 35 UK patients (24 F, median age 42y, range 17-64). Overall characteristics were comparable, although the UK cohort included more patients with a mutation in CFH SCR 20 / hybrid gene (31% versus 5%; p<0.01), whereas NL patients more often received a living donor kidney (66% versus 20%; p <0.001). The majority of the NL patients (74%) was transplanted using low dose tacrolimus (TAC). Eighteen (47%) NL patients were treated with eculizumab rescue therapy. Follow-up was comparable, NL 70.8m (range 10-134), and UK 55.4m (range 2-95). There were no significant differences in death-censored graft survival between the two cohorts (Figure).

Conclusion

Eculizumab rescue therapy was not inferior to eculizumab prophylaxis with respect to death-censored graft survival. Limitation: this conclusion holds for use of rescue therapy in a population characterized by low prevalence of “very high risk” genes, low TAC levels, and predominant use of living donor kidneys.

Funding

  • Commercial Support – This work was supported by research grants from the Dutch Board of Health Insurance Companies (Zorgverzekeraars Nederland).