Alemtuzumab Induction and Post-Transplant Glomerulonephritis in Kidney Transplantation.

Abstract

Background: The incidence and nature of Post-Transplant Glomerulonephritis (PTGN) in patients receiving Alemtuzumab induction has been rarely reported. In this study we investigate the incidence of PTGN and its effect on outcomes in kidney transplant recipients receiving a steroid sparing immunosuppressive regime with Alemtuzumab induction. Methods: We retrospectively reviewed the medical records of 848 (544 male, mean age 48.4 +/- 13.3 years) kidney transplant recipients in our centre between November 2005 and June 2013 for the occurrence of PTGN. All the patients received a steroid sparing immunosuppressive regime with Alemtuzumab induction and tacrolimus monotherapy. Steroids and MMF were only introduced to treat rejection. Results: 66 out of 848 patients (7.8%) developed biopsy proven PTGN. A male predominance was found in the PTGN group (9.56% male vs 4.8% female, p=0.01), while PTGN was found not to be related to ethnicity (p=0.404), or donor type (p=0.167). Mean follow up of PTGN patients was 40.3 (+24.5) months and mean time from transplantation to diagnosis was 20.4 (+20.2) months. Out of 66 PTGN patients, 16(1.9%) were diagnosed with Focal Segmental Glomerulosclerosis (FSGS), 37(4.4%) IgA Nephropathy (IGAN), 2(0.2%) Lupus nephritis(LN), 3(0.4%) Membranous Nephropathy (MN) and 8(0.9%) with other PTGN's.Table: No Caption available.There was no difference in patient survival between the PTGN and the non-PTGN groups at 1 (98.4 vs 97.8%) and 3 years (96.7% vs 94.3%) post transplantation. (p=0.2) Censored allograft survival did not differ between the 2 groups (95.6% and 91.1% in the PTGN vs. 100% and 88.3% in the non-PTGN group at 1 and 3 years; p=0.11). When stratified according to diagnosis, censored allograft survival was found to be lower in the patients diagnosed with FSGS (100% and 67.3% at 1 and 5 years) when compared to the non-PTGN group (95.6% and 87.1%% at 1 and 5 years). (p=0.02) Conclusion: Although these are medium term data, the incidence of PTGN in patients receiving Alemtuzumab induction appears similar to other induction agents. Post-transplant FSGS is associated with a poor prognosis and we are developing new strategies to deal with this problem.