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Kidney Week

Abstract: SA-PO379

Infectious Complications with Two Different Induction Regimens After Pediatric Kidney Transplantation

Session Information

  • Pediatric Nephrology - III
    November 04, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

  • 1900 Pediatric Nephrology

Authors

  • Chandar, Jayanthi, University of Miami, Miami, Florida, United States
  • Defreitas, Marissa J., University of Miami, Miami, Florida, United States
  • Sigurjonsdottir, Vaka, University of Miami, Miami, Florida, United States
  • Katsoufis, Chryso P., University of Miami, Miami, Florida, United States
  • Seeherunvong, Wacharee, University of Miami, Miami, Florida, United States
  • Abitbol, Carolyn L., University of Miami, Miami, Florida, United States
  • Ciancio, Gaetano, University of Miami, Miami, Florida, United States

Group or Team Name

  • University of Miami.
Background

Pediatric kidney transplant recipients are vulnerable to clinically significant viral replication (VR) because of their need for intense induction and ongoing need for maintenance immune suppression (ISP). In this single-center study we compare the incidence of VR with CMV, EBV, parvovirus, BKV and infectious complications on an induction regimen with anti-thymocyte globulin (ATG) consisting of 3 mg/kg (HiATG) versus <3mg/kg (LoATG) and those who did not receive ATG (NoATG).

Methods

Retrospective analysis was performed in 59 patients with isolated kidney transplants from January 2018 to December 2021. The protocol for HiATG was a cumulative dose of 3mg/kg in the years 2018 -2019 which changed to 1 mg/kg in 2020-2021 for LoATG. Those with low pre-transplant vaccine response and/or low CD4 counts received NoATG. Induction ISP included basiliximab and methylprednisolone. VR was defined if PCR was > 137 copies/ml. Discontinuation of anti-metabolites or specific treatment for viral infection defined viral disease. Rejection was confirmed by kidney biopsy.

Results

Median age was 14 years (IQR: 9.5-17). There were no significant differences in the incidence of VR and rejection between HiATG and LoATG in the first 6 post-transplant months. All patients in NoATG had VR (See Table). Opportunistic infections were observed more often in NoATG. Although steroid avoidance was possible in LoATG and HiATG, time to steroid withdrawal was longer in LoATG (p = 0.02). Leukopenia was more prevalent in HiATG. After 6 months of transplant, VR occurred in 4 patients in each of HiATG and LoATG groups with one patient developing post-transplant lymphoproliferative disease during a mean follow-up period of 33±14 months.

Conclusion

Infectious complications occur in all induction regimens. In addition, maintenance ISP contributes to lowering host immunity. Differences in host response are likely to play a significant role in propensity to infections, highlighting the importance of individualizing ISP.

Clinical Characteristics in the First 6 Post-transplant Months
ATG dose (mg/kg) ‡Patients†Viral Replication†Viral disease†Opportunistic Infections†Leukopenia†Steroid free†Steroid withdrawal days‡Rejection†
3 (3-3)25 (42)14 (56)5 (20)1 (4)11 (44)21 (84)7 (7-15)2 (8)
1 (1-2)30 (51)18 (60)3 (10)1 (3)8 (27)25 (83)19 (8-30)*2 (7)
None4 (7)4 (100)03 (75)3 (75)1 (25)350

*P <=0.02; †N (%); ‡median(IQR)