200 Living Donor Kidney Transplantations Under Alemtuzumab Pretreatment and Weaning of Tacrolimus Monotherapy: 3 Year Follow Up

Abstract

2 7 7 THURSDAY Supplement to Transplantation July 27, 2008, Volume 86 Number 2S corticosteroids, antithymocyte globulin and/or daclizubab. From Jan. 2004 to Dec. 2007 received rituximab in addition to the "standard" immunosuppression. Posttransplant proteinuria was treated with plasmapheresis (PP) and maintenance angiotensin blockade (AB). Results: There was no adverse event related to rituximab infusion. The overall incidence of posttransplant proteinuria was signifi cantly lower in recipients with rituximab induction (p < 0.05). Four recipients treated with "standard" immunosuppression developed massive proteinuria (u-protein/creat. > 10) immediately following transplantation; they responded poorly to PP and AB. Four other recipients had moderate proteinuria. In contrast to this, of the 18 patients induced with rituximab, only 2 had massive proteinuria and 4 had mild to moderate proteinuria which responded well to PP and AB. With a median follow-up of 26 months, there was no signifi cant difference of graft survival between 2 groups (2-year survival: 81% without rituximab vs. 84% with rituximab). A half of the graft loss was related to noncompliance. Conclusion: While the mechanism of action is unclear, our observation indicates that rituximab induction may decrease the incidence and severity of recurrence of FSGS following kidney transplantation. A larger-scale study is desirable to confi rm this observation. Alemtuzumab has been used in off-label studies of solid organ transplantation. We extend our report of the fi rst 200 consecutive living donor solitary kidney transplantations under alemtuzumab pretreatment with tacrolimus monotherapy and subsequent spaced weaning to 3 years of follow up. We focused especially on the causes of recipient death and graft loss, and the characteristics of rejection. The actuarial 1, 2, and 3 year patient and graft survivals were 99.0% and 98.0%, 96.4% and 90.8%, and 93.3% and 86.3%, respectively. The incidence of acute cellular rejection (ACR) at the following months was 2% <6, 9.0% <12, 16.5% <18, 19.5% <24, 23.5% <30, 24.0% <36, and 25% <42. The mean serum creatinine (mg/dL) and glomerular fi ltration rate (mL/min/1.73m2) at 1 and 3 years were 1.43+0.55 and 58.7+21.6, and 1.50+0.71 and 54.5+21.3, respectively. 50 (25%) recipients had a total of 89 episodes of ACR. 88.7% of ACR episodes were Banff 1, and of those, 82% were steroid-sensitive. Nine (4.5%) recipients had antibody mediated rejection (AMR). 76.5% were weaned to spaced dose (qod or less) tacrolimus monotherapy, and 94.4% were still steroid-free from the time of transplantation. Infectious complications was low. This experience confi rms the 3-year effi cacy of this approach. Introduction: We evaluated early and long-term (two year) immunophenotypic peripheral blood profi les in renal transplant patients receiving single agent induction therapy with Thymoglobulin (T), Campath-1H (alemtuzumab) (C) or Daclizumab (D) versus combined T and D (T-D) or T and C (T-C) with steroid avoidance. The focus was to identify spec...