A Randomized Trial of Alemtuzumab Versus Antithymocyte Globulin Induction in Renal and Pancreas Transplantation

Abstract

BACKGROUND.: Alemtuzumab and rabbit antithymocyte globulin (rATG) are commonly used for induction of immunsuppression for kidney and pancreas transplantation, but the two agents have not been compared directly. METHODS.: We conducted a prospective randomized single-center trial comparing alemtuzumab and rATG induction in adult kidney and pancreas transplantation in patients treated with similar maintenance immunosuppression. RESULTS.: Between February 1, 2005, and September 1, 2007, 222 patients randomly received either alemtuzumab (n=113) or rATG (n=109) induction; 180 (81%) underwent kidney alone, 38 (17%) simultaneous pancreas-kidney, and 4 (2%) pancreas after kidney transplants. Of 180 kidney-alone transplants, 152 (84%) were from deceased donors, including 61 (34%) from expanded criteria donors. Retransplantation, human leukocyte antigen match, antibody titer, expanded criteria donors, race, cytomegalovirus status, delayed graft function, and immunologic risks were similar between the two induction groups. With a median follow-up of 2 years (minimum 1 year), overall patient, kidney, and pancreas graft survival rates were 96%, 89%, and 90%, respectively. Survival, initial length of stay, and maintenance immunosuppression (including early steroid elimination) were similar between alemtuzumab and rATG groups, but biopsy-proven acute rejection (BPAR) episodes occurred in 16 (14%) alemtuzumab patients compared with 28 (26%) rATG patients (P=0.02). Late BPAR (>12 months after transplant) occurred in 1 (8%) alemtuzumab patient and 3 (11%) rATG patients (P=NS). Infections and malignancy were similar between the two induction arms. CONCLUSION.: Alemtuzumab and rATG induction therapies were equally safe, but alemtuzumab was associated with less BPAR.

Singlevsdual (en bloc) kidney transplants from donors ≤ 5 years of age: A single center experience

“…Daily immunosuppression maintenance therapy included mycophenolate mo fetil, tacrolimus, and either early corticosteroid with drawal or rapid tapering as previously reported [36] . Ultrasoundguided percutaneous kidney biopsies were performed to evaluated renal allograft dysfunction and to diagnosis and grade acute rejection.…”

Current Immunosuppression in Abdominal Organ Transplantation

“…Most pancreas transplant recipients receive induction therapy with T-cell-depleting agents thymoglobulin or alemtuzumab and maintenance immunosuppression with a combination of CNI (mostly tacrolimus), mycophenolate mofetil, sirolimus and rapid steroid withdrawal (review in Heilman et al, 2010). The incidence of acute rejection after pancreas transplant is reported between 20 and 35% at 3 years (Farney et al, 2009). Like in kidney transplant, the combination of sirolimus with full dose CNI may accentuate nephrotoxicity.…”

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“…Alemtuzumab does not increase rates of BK viruria, BK viremia, or BKV nephropathy compared with that shown with nonlymphocyte-depleting therapy. [47][48][49] Cyclosporine is believed to be associated with a lower incidence of BKV nephropathy than tacrolimus, and mycophenolate mofetil is associated with a higher incidence of treatment for BKV compared with no antimetabolite therapy or azathioprine. 9,50-52 Whereas Retrospective cohort study 666 patients from January Induction with Alemtuzumab did not increase et al 49 2008 to August 2010 alemtuzumab vs the incidence of BK virus non-lymphocyte-depleting reactivation agents Abbreviations: BKVAN, BK virus-associated nephropathy; MMF, mycophenolate mofetil; OPTN, Organ Procurement and Transplantation Network; SRTR, Scientific Registry of Transplant Recipients data on mammalian target of rapamycin inhibitors, sirolimus and everolimus, are limited, it would be safe to state that they are not associated with an increased risk of BKV nephropathy.…”