Campath Preconditioning and Tacrolimus Monotherapy With Subsequent Weaning in Renal Transplant Recipients

Living-Related Donor Renal Transplantation in HIV+ Recipients using Alemtuzumab Preconditioning and Steroid-Free Tacrolimus Monotherapy: A Single Center Preliminary Experience

“…Recent data demonstrate that recipient pretreatment with Thymoglobulin, a T-cell depleting agent followed by minimal use of posttransplant immunosuppression, permits a dramatic ability to wean immunosuppression (10,11,14), and similar findings have been demonstrated using alemtuzumab preconditioning (13). The exact mechanism remains to be elucidated and we are in the process of elucidating this high frequency of profound in vitro hyporesponsiveness induced by alemtuzumab preconditioning (16).…”

“…Recent data demonstrate that recipient pretreatment with rabbit anti-thymocyte globulin (Thymoglobulin), a T-cell depleting agent, followed by minimal use of posttransplant immunosuppression, permits a dramatic ability to wean immunosuppression (10,11). More recently, preconditioning with alemtuzumab (Campath-1H, Millennium Pharmaceuticals, Cambridge, MA), a humanized anti-CD52 monoclonal antibody (12,13), has been used instead of Thymoglobulin (14), with excellent early outcomes. A similar approach may be of benefit in HIV+ patients by permitting the weaning of maintenance immunosuppression.…”

Acute Cellular Rejection Predominated by Monocytes Is a Severe Form of Rejection in Human Renal Recipients With or Without Campath-1H (Alemtuzumab) Induction Therapy

“…The beneficial effects of Campath‐1H induction and postoperative immunosuppression in renal transplantation was first reported by Calne et al in 1998 (16). Recent preliminary data from several other groups and us support that this combinational approach to therapy has resulted in a low rate of ACR (average 13%) with no increase in complications (9–12). We noted that renal transplant recipients with Campath‐1H induction frequently developed ACR with a majority of the cells (up to 95%) being monocytes and a minority T lymphocytes; whereas monocytes were mixed with many other inflammatory cells including T lymphocytes, eosinophils and neutrophils in renal specimens from those who did not receive Campath‐1H induction.…”

“…We noted that renal transplant recipients with Campath‐1H induction frequently developed ACR with a majority of the cells (up to 95%) being monocytes and a minority T lymphocytes; whereas monocytes were mixed with many other inflammatory cells including T lymphocytes, eosinophils and neutrophils in renal specimens from those who did not receive Campath‐1H induction. Since Campath‐1H can severely deplete peripheral T lymphocytes to minimal levels and, to a lesser extent, deplete monocytes (8–12), monocyte‐mediated ACR, following Campath‐1H induction, appeared to develop with minimal assistance from T lymphocytes. When no Campath‐1H was used, involvement of monocytes in ACR occurred under a full capacity of T lymphocyte function.…”

“…During the fifth Joint Meeting of American Society of Transplantation and American Society of Transplant Surgeons (May 2004), we and several other groups presented favorable results with Campath‐1H induction, plus varying regimens of postoperative immunosuppression, in renal transplantation: in terms of its safety, low rejection rate and low incidence of associated infection (9–12). In a case report, we recently observed a monocyte‐mediated ACR in a renal transplant recipient with both intraoperative Campath‐1H induction and postoperative immunosuppression (13).…”