P-165

Simultaneous kidney-pancreas transplantation in African-American recipients: Alemtuzumab versus rATG induction

R. Stratta, A. Farney, J. Rogers, S. Al-geizawi, W. Doares, S. Kaczmorski, S. Winfrey, M. Gautreaux, L. Hart, S. Iskandar
Wake Forest Univ School of Medicine, General Surgery, Winston-Salem, NC, USA

Outcomes of Alemtuzumab (Alem) and rATG induction in African-American (AA) simultaneous kidney-pancreas transplant (SKPT) patients (pts) are not well described.

Methods: We performed 26 SKPTs (21%) in AA pts with Alem or rATG induction with FK, MMF, and steroids.

Results: 12 AA pts received Alem and 14 rATG. Demographics were similar between groups. Detectable pretransplant (pretx) C-peptide levels were present in 4 Alem pts (mean 3.7 ng/ml) and 3 rATG pts (mean 6.4 ng/mL), suggesting a type 2 diabetes phenotype. With a mean follow-up of 46 months, actual pt (100% Alem vs 93% rATG), kidney (92% Alem vs 50% rATG, p=0.036), and pancreas (83% Alem vs 57% rATG, p=0.22) graft survival rates (GSR) favored the Alem group. Relaparotomy rates were 25% in Alem pts vs 50% in rATG pts (p=0.25). Initial lengths of hospital stay and infection rates were similar between groups. Acute rejection (AR) occurred in 17% of Alem vs 50% (p=0.11) of rATG pts. In pts with functioning grafts, most recent serum creatinine (mean 1.2 mg/dL Alem vs 1.6 rATG), eGFR (mean 58 mL/min Alem vs 53 rATG), C-peptide (mean 3.0 ng/mL Alem vs 4.1 rATG) and HbA1c levels (mean 5.5%, both groups) were comparable between groups. 6/8 (75%) kidney grafts were lost to AR, whereas pancreas grafts failed due to thrombosis (2), chronic rejection (2), and insulin resistance (4 pts, 3 with detectable pretx C-peptide levels). Pancreas graft loss rates (excluding thrombosis) were 43% vs 18% (p=0.31) in pts with and without detectable pretx C-peptide levels, respectively.

Conclusions: Alem and rATG induction are both associated with good initial outcomes in AA recipients of SKPT. Alem induction may be associated with a reduction in early morbidity. Detectable pretx C-peptide levels are not a contraindication to SKPT but may be a risk factor for pancreas graft failure.

P-165

Simultaneous kidney-pancreas transplantation in African-American recipients: Alemtuzumab versus rATG induction

R. Stratta, A. Farney, J. Rogers, S. Al-geizawi, W. Doares, S. Kaczmorski, S. Winfrey, M. Gautreaux, L. Hart, S. Iskandar
Wake Forest Univ School of Medicine, General Surgery, Winston-Salem, NC, USA

Outcomes of Alemtuzumab (Alem) and rATG induction in African-American (AA) simultaneous kidney-pancreas transplant (SKPT) patients (pts) are not well described.

Methods: We performed 26 SKPTs (21%) in AA pts with Alem or rATG induction with FK, MMF, and steroids.

Results: 12 AA pts received Alem and 14 rATG. Demographics were similar between groups. Detectable pretransplant (pretx) C-peptide levels were present in 4 Alem pts (mean 3.7 ng/ml) and 3 rATG pts (mean 6.4 ng/mL), suggesting a type 2 diabetes phenotype. With a mean follow-up of 46 months, actual pt (100% Alem vs 93% rATG), kidney (92% Alem vs 50% rATG, p=0.036), and pancreas (83% Alem vs 57% rATG, p=0.22) graft survival rates (GSR) favored the Alem group. Relaparotomy rates were 25% in Alem pts vs 50% in rATG pts (p=0.25). Initial lengths of hospital stay and infection rates were similar between groups. Acute rejection (AR) occurred in 17% of Alem vs 50% (p=0.11) of rATG pts. In pts with functioning grafts, most recent serum creatinine (mean 1.2 mg/dL Alem vs 1.6 rATG), eGFR (mean 58 mL/min Alem vs 53 rATG), C-peptide (mean 3.0 ng/mL Alem vs 4.1 rATG) and HbA1c levels (mean 5.5%, both groups) were comparable between groups. 6/8 (75%) kidney grafts were lost to AR, whereas pancreas grafts failed due to thrombosis (2), chronic rejection (2), and insulin resistance (4 pts, 3 with detectable pretx C-peptide levels). Pancreas graft loss rates (excluding thrombosis) were 43% vs 18% (p=0.31) in pts with and without detectable pretx C-peptide levels, respectively.

Conclusions: Alem and rATG induction are both associated with good initial outcomes in AA recipients of SKPT. Alem induction may be associated with a reduction in early morbidity. Detectable pretx C-peptide levels are not a contraindication to SKPT but may be a risk factor for pancreas graft failure.