Abstract

O240 Background: Recently, we have used an anti T-cell agent, alemtuzumab as induction or conversion therapy to achieve a calcineurin (CNI) and steroid-free immunosuppressive regimen. We identified recipients that developed systemic fungal infections after the initiation of alemtuzumab and looked at their outcomes. Methods: The study population consisted of all pancreas transplant recipients that received alemtuzumab- either as part of induction, or as part of a posttransplant CNI withdrawal protocol (usually done because of renal dysfunction). Only invasive fungal infections were included in the analysis (e.g. fungemia, meningitis or pneumonia—excluded were fungal urinary tract infections). The organism was confirmed by culture, histopathology, or latex antigen test. Results: Between February 2003 and February 2004, a total of 121 pancreas transplant recipients received alemtuzumab- 56 as part of induction, and 65 as part of conversion. Of these, 7 (5.8%) developed an invasive fungal infection; 2 (3.6%) recipients as part of induction therapy and 5 (7.7%) as part of conversion therapy. Mean recipient age was 42.3 years. Category of transplant was as follows: SPK (n=3, 43%) and PAK (n=4, 57%). The mean length of time from alemtuzumab administration (1st dose) to the diagnosis of the fungal infection was 114.9 days (range 8-318). The organisms identified initially were: Cryptococcus neoformans (n=3, 43%), Histoplasma capsulatum (n=2, 29%), Actinomyces israelii (n=1, 14%), and Candida albicans (n=1, 14%). Initial sites of infections were: bloodstream (n=3, 43%), pulmonary (n= 3, 43%) and soft tissue (n=1, 14%). Overall, 3 (43%) of the 7 patients died during ongoing treatment of their fungal infection: 1 from sepsis during the initial treatment of histoplasmosis fungemia, 1 from Aspergillus CNS infection after initial treatment for buccal actinomycosis, and 1 due to MI while receiving treatment for diffuse Cryptococcus soft tissue infection. The other 4 recipients were treated successfully and have functioning grafts. The initial therapeutic agents used included: amphotericin B/liposomal AMB (n=5), voriconazole (n=3), capsofungin (n=1) and penicillin (n=1). Conclusions: The use of alemtuzumab as induction or conversion therapy in pancreas transplant recipients may predispose patients to the development of systemic fungal infections. It would be important to determine what the most appropriate prophylaxis regimen would be for these patients.

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