Present experience with Campath‐1H in organ transplantation and its potential use in pediatric recipients

Knechtle, Stuart J.

doi:10.1046/j.1399-3046.2003.00139.x

Cited by 38 publications

(34 citation statements)

References 32 publications

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“…61,62 The prolonged depletion obtained with alemtuzumab (a potent monoclonal anti-CD52 antibody) in children is in conflict with the general theory that depletion would be more transient in children, owing to more active lymphopoiesis, than in adults. 63 Induction therapy with rabbit antithymocyte globulin (ATG), a polyclonal depleting agent, promotes long-term graft survival in pediatric kidney-transplant recipients, 64 with depletion of naive T cells and central memory T cells and little effect on effector memory T cells. 65 In addition, regulatory T cells (Tregs) were spared with alemtuzumab and expanded with ATG, 65 conferring an additional immunologic benefit by helping to accommodate the graft.…”

Section: Pedi Atr Ic Immunosuppr Ession -Lessons From Clinic a L Tr Imentioning

confidence: 99%

Kidney Transplantation in Children

2014

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Section: Pedi Atr Ic Immunosuppr Ession -Lessons From Clinic a L Tr Imentioning

confidence: 99%

Kidney Transplantation in Children

2014

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“…(55), the experiences with this agent in renal transplantation have been promising (13)(14)(15)(16)18,(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)54,56). …”

Section: If/ta Nes (Can) To Define the Degree Of If/ta Nes (Can) In Omentioning

confidence: 99%

Two Hundred Living Donor Kidney Transplantations Under Alemtuzumab Induction and Tacrolimus Monotherapy: 3-Year Follow-Up

Tan

Donaldson

Basu

et al. 2009

American Journal of Transplantation

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Alemtuzumab has been used in off-label studies of solid organ transplantation. We extend our report of the first 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 cumulative 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 filtration rate (mL/min/1.73 m 2 ) at 1 and 3 years were 1.4 ± 0.6 and 58.7 ± 21.6 and 1.5 ± 0.7 and 54.9 ± 20.9, respectively. Fifty (25%) recipients had a total of 89 episodes of ACR. About 88.7% of ACR episodes were Banff 1, and of those, 82% were steroid-sensitive. Nine (4.5%) recipients had antibodymediated rejection (AMR). About 76.5% were weaned but only 46% are currently on spaced dose (qod or less) tacrolimus monotherapy, and 94.4% remained steroidfree from the time of transplantation. Infectious complications were uncommon. This experience suggests the 3-year efficacy of this approach.

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“…17 The recovery rates in adults were achieved with immunosuppression protocols similar to that used in this study. Trzonkowsi et al used an induction regimen of alemtuzumab, followed by a steroid-free maintenance regimen consisting initially of mycophenolate mofetil (MMF) and tacrolimus; tacrolimus was switched to sirolimus at 6 months, whereas MMF was discontinued at 12 months.…”

Section: Discussionmentioning

confidence: 99%

Immune Profile of Pediatric Renal Transplant Recipients following Alemtuzumab Induction

Serres

Mfarrej

Magee

et al. 2012

Journal of the American Society of Nephrology

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The incidence of developing circulating anti-human leukocyte antigen antibodies and the kinetics of T cell depletion and recovery among pediatric renal transplant recipients who receive alemtuzumab induction therapy are unknown. In a collaborative endeavor to minimize maintenance immunosuppression in pediatric renal transplant recipients, we enrolled 35 participants from four centers and treated them with alemtuzumab induction therapy and a steroid-free, calcineurin-inhibitor-withdrawal maintenance regimen. At 3 months after transplant, there was greater depletion of CD4 + than CD8 + T cells within the total, naive, memory, and effector memory subsets, although depletion of the central memory subset was similar for CD4 + and CD8 + cells. Although CD8 + T cells recovered faster than CD4 + subsets overall, they failed to return to pretransplant levels by 24 months after transplant. There was no evidence for greater recovery of either CD4 + or CD8 + memory cells than naïve cells. Alemtuzumab relatively spared CD4 + CD25 + FoxP3 + regulatory T cells, resulting in a rise in their numbers relative to total CD4 + cells and a ratio that remained at least at pretransplant levels throughout the study period. Seven participants (20%) developed anti-human leukocyte antigen antibodies without adversely affecting allograft function or histology on 2-year biopsies. Long-term follow-up is underway to assess the potential benefits of this regimen in children.

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Present experience with Campath‐1H in organ transplantation and its potential use in pediatric recipients

Cited by 38 publications

References 32 publications

Kidney Transplantation in Children

Kidney Transplantation in Children

Two Hundred Living Donor Kidney Transplantations Under Alemtuzumab Induction and Tacrolimus Monotherapy: 3-Year Follow-Up

Immune Profile of Pediatric Renal Transplant Recipients following Alemtuzumab Induction

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