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Lookup NU author(s): Emily Glover, Professor David KavanaghORCiD, Professor Neil SheerinORCiD
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
Background: Guidelines advise eculizumab prophylaxis for most aHUS kidney transplant recipients. However, recurrence rates may be overestimated and starting eculizumab at relapse (“rescue therapy”) may prevent graft loss. Randomized controlled trials have not compared efficacy, safety, and costs of different treatment strategies. We performed a comparative study, including a previously described Dutch cohort treated with rescue therapy and a UK cohort using eculizumab prophylaxis. Methods: In the Netherlands (NL) we selected all adult aHUS patients who received a kidney transplant between 2010-2021 in the Radboudumc (n=30), and enriched this cohort with 8 patients who received rescue therapy in other centers. The UK cohort included all adult aHUS patients at moderate or high risk of recurrence, transplanted between 2013 and 2017 with prophylactic eculizumab. Results: We included 38 Dutch patients and 35 UK patients. Characteristics were comparable, although the UK cohort included more patients with a CFH SCR 20 mutation or hybrid gene (31% versus 5%; p<0.01), and more Dutch patients received living donor kidneys (66% versus 20%; p <0.001). Follow-up was comparable (NL 70.8m, range 10-134, UK 55.4m, range 2-95). Eighteen (47%) Dutch patients received rescue therapy. Death-censored graft survival was not significantly different (NL 1-y, 3-y and 6-y: 97.4%, 91.2%, and 87.1%, UK 1-y, 3-y and 6-y: 97.1%, 88.2%, and 65.6%, log-rank P = 0.189). Conclusion: In a population characterized by low prevalence of “very high risk” genes, who were predominantly transplanted using an endothelial protective regime, death-censored graft survival with eculizumab rescue therapy was not inferior to prophylaxis.
Author(s): Duineveld C, Glover EK, Bouwmeester RN, van de Kar NCAJ, Kavanagh D, Wetzels JFM, Sheerin NS
Publication type: Article
Publication status: Published
Journal: Transplantation
Year: 2024
Pages: epub ahead of print
Online publication date: 25/07/2024
Acceptance date: 27/05/2024
Date deposited: 27/05/2024
ISSN (print): 0041-1337
ISSN (electronic): 1534-6080
Publisher: Lippincott Williams & Wilkins
URL: https://doi.org/10.1097/TP.0000000000005135
DOI: 10.1097/TP.0000000000005135
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