To retain the Accessibility I have been inform you need to do the following.

File>Save & Send>Create PDF/XPS Document
I check the right boxes in the options; "Document structure tags for Accessibility"

To transfer the Alt Text for Accessibility issues, this has been the primary way to go by this listed on the web.

I might try that, but still working the PDF after it is made isn't helping ether.
I guess I can always give that a try.