232.5: Rate of opportunistic infection within 3 years after renal transplant using induction with alemtuzumab versus basiliximab.

Abstract

Background: Induction immunosuppression in organ transplantation has yielded improved early graft function and decreased acute-rejection rates. However, infection risk remains a topic of investigation, particularly between different induction agents. The aim of our study was to compare clinical outcomes during the first 3-years after renal transplantation, with the focus on opportunistic infections, in patients who received either alemtuzumab or basiliximab for induction therapy. Methods: We included all renal transplant recipients from our center who received induction with alemtuzumab between 2011 and 2016. These patients were matched 1:2 (by age and date of transplant) to renal transplant recipients who received basiliximab. Electronic medical records were searched for evidence of the following opportunistic infections within the first 3 years after transplant; BK virus, CMV, VZV, HSV, Cryptococcus, and Histoplasma. Continuous variables were compared using t-tests or Wilcoxon rank-sum tests and categorical variables using Fisher’s tests or chi-square tests. Binary outcomes were compared using Cochran-Mantel-Haenszel tests. Time-to-event outcomes were plotted using the Kaplan-Meier method and compared between groups using log-rank tests. Results: Patients’ demographics and select results are presented in the Table. There were no statistically significant differences in delayed graft function (p = 0.76), graft loss (p = 0.99), or rejection (p = 0.2). Opportunistic infection rates were also not significantly different during the first 3-years post-transplantation (p = 0.87). Time-to-infection (Figure 1) (p = 0.67), time-to-death (p=0.21), and time-to-rejection (p = 0.098) were similar in both groups Conclusions: Despite a difference in immunological risk between the 2 groups, we did not detect any significant differences in outcomes at 3-years post-transplantation between higher immunological risk patients receiving alemtuzumab and lower immunological risk patients receiving basiliximab. Despite previous concerns about CMV reactivation with Alemtuzumab use, infection rates were similar between groups. Surprisingly, no fungal infections were detected at 3-years post-transplant, which may represent a delay in detection of any potential risk differences.