TO018TIMING OF ECULIZUMAB INITIATION AND THE NEED FOR DIALYSIS IN PATIENTS WITH ATYPICAL HAEMOLYTIC URAEMIC SYNDROME UNDERGOING KIDNEY TRANSPLANTATION

Abstract

INTRODUCTION AND AIMS: Patients (pts) with atypical haemolytic uraemic syndrome (aHUS) are at risk of thrombotic microangiopathy (TMA) and graft loss following transplantation. Eculizumab (Ecu), a terminal complement inhibitor, is effective in preventing and treating TMA in pts with aHUS and is increasingly used post-kidney transplant (KTx). We report data on dialysis rate in aHUS pts post-KTx in relation to the timing of Ecu initiation METHODS: Our analyses utilised data from a Global aHUS Registry (NCT01522183) in which 1286 pts with aHUS were enrolled as of August 2016. 147 pts who had >=1 KTx, received Ecu and had >=1 year of Registry follow-up post-KTx were included in the analyses. Pts were grouped by time of Ecu initiation (initiation up to and including day of KTx [pre-KTx; n=69] vs initiation post-KTx [n=78]). Data from patients who discontinued Ecu or were treated outside of SmPC recommendations were also included. RESULTS: Pts starting Ecu post-KTx were older, less likely to have a family history of aHUS, and fewer had undergone dialysis in the 12 months prior to KTx (Table). More pts treated with Ecu post-KTx required new dialysis (28 vs 6) and had dialysis more frequently (7.6 vs 3.0 /100 pt years) than pts receiving Ecu pre-KTx (Figure). Pts who received Ecu post-KTx experienced more TMA events (106 vs 17) more frequently (11.7 vs 4.0 /100 pt years) post-KTx than pts treated with Ecu pre-KTx. Multivariate analysis showed pts starting Ecu post-KTx were more likely to require dialysis post KTx than pts starting Ecu pre-KTx (hazard ratio [HR] 3.02; 95% confidence interval [CI] 1.19-7.69). The severity and frequency of targeted adverse events were similar irrespective of when Ecu was initiated. CONCLUSIONS: This retrospective analysis shows that KTx pts with aHUS in whom treatment with Ecu is initiated prior to transplant have a lower rate of TMA and dialysis post-transplant. Further assessment of the group that received Ecu posttransplant is ongoing as a significant number of this group were diagnosed with aHUS post-transplant. Figure. Cumulative proportion of pts receiving dialysis post-transplant.