Alemtuzumab Induction and Steroid Minimization in IgA Nephropathy: A Matched-Cohort Analysis

Immunoglobulin A nephropathy is the most common primary glomerulonephritis in adults. Transplant can be complicated by immunoglobulin A nephropathy recurrence in up to 60% of allografts, sometimes causing graftloss.The use of alemtuzumab for induction therapy in the setting of steroid minimization for recipients with immunoglobulin A nephropathy is unclear. Here, we investigated patient and graft outcomes in patients with this condition who were induced with alemtuzumab and a steroid minimization protocol.

We performed a retrospective analysis of a database containing 29 patients with immunoglobulin A nephropathy and 646 other recipients who underwent transplant and were induced with alemtuzumab and steroid minimization treatment between March 2006 and May 2015. A matched cohort generated using propensity scoring was also analyzed.

Recipients with immunoglobulin A nephropathy were significantly younger at transplant (37.3 ± 11.9 vs 55.6 ± 13.4 years; P < .001), less likely to be African American (6.9% vs 23.2%; P = .04), less likely to have diabetes mellitus (10.3% vs 39.8%; P < .001), and more likely to have private insurance (72.4% vs 45.9%; P = .007). There were no significant differences in graft and patient survival. Recipients with immunoglobulin A nephropathy experienced a higher rate of 1-year rejection (24.1% vs 21.4%; P = .043). Of the 29 patients with immunoglobulin A nephropathy, 8 experienced recurrence (27.6%; average time of 1120.5 ± 982.9 days), with all 8 patients having allograftloss. Matched pair analyses did not yield significant differences in outcomes.

Recurrence rate of immunoglobulin A nephropathy in those induced with alemtuzumab in the setting of steroid minimization is similar to previously reported rates. Although recipients with immunoglobulin A nephropathy had significantly higher 1-year rejection rate, no other differences in graft or patient survival were shown versus recipients without this condition.