Infliximab induction therapy fails to protect kidney transplants and appears to increase the risk of BK virus infection in recipients, investigators report.
Peter Heeger, MD, of the Comprehensive Transplant Center at Cedars Sinai Medical Center in West Hollywood, California, and colleagues randomly assigned 225 unsensitized recipients of deceased-donor kidneys to receive intravenous infliximab (3 mg/kg) or saline placebo prior to kidney reperfusion. All patients also received rabbit anti-thymocyte globulin induction and maintenance immunosuppression with tacrolimus, mycophenolate mofetil, and prednisone.
At day 7 after transplantation, production of tumor necrosis factor alpha linked to allograft inflammation had fallen a significant 10-fold in the infliximab vs placebo group. Yet estimated glomerular filtration rate (eGFR) did not differ significantly between the infliximab and placebo groups at 24 months after transplantation: 52.45 vs 57.35 mL/min/1.73 m2, Dr Heeger and his peers reported in the Journal of the American Society of Nephrology. The investigators also found no significant improvement in rates of delayed graft function, biopsy-proven acute rejection, development of de novo donor-specific antibodies, or graft loss/death.
BK viremia (45.6% vs 28.6%) and BK viremia requiring a change in immunosuppression or antiviral medication (28.9% vs 13.4%) occurred in significantly higher proportions of the infliximab than placebo group, the investigators reported. BK virus nephropathy followed a similar trend 13.3% vs 4.9%, respectively. Infliximab did not affect rates of cytomegalovirus.
“As [infliximab] induction increased rates of BK infection, our findings underscore the complexities of targeting peritransplant inflammatory effectors as a strategy to improve kidney transplant outcomes,” Dr Heeger’s team wrote.
Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Hricik D, Armstrong B, Alhamad T, et al. Infliximab induction lacks efficacy and increases BK virus infection in deceased donor kidney transplant recipients. J Am Soc Nephrol 34(1):145-159. doi:10.1681/ASN.2022040454