Alemtuzumab Induction and Antibody-Mediated Rejection in Kidney Transplantation

• Published in: Transplantation proceedings Vol. 46; no. 10; pp. 3405 - 3407
• Main Authors: Noureldeen, T, Albekioni, Z, Machado, L, Muddana, N, Marcus, R.J, Hussain, S.M, Sureshkumar, K.K
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2014
• Subjects: Alemtuzumab; Antibodies, Monoclonal, Humanized - pharmacology; Antineoplastic Agents - pharmacology; B-Lymphocytes - drug effects; B-Lymphocytes - immunology; Female; Graft Rejection - immunology; Graft Rejection - prevention & control; Graft Survival; Humans; Kidney Transplantation; Male; Middle Aged; Retrospective Studies; Surgery
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2014.08.037

Abstract Background Induction therapy improves graft outcomes in kidney transplant recipients (KTRs). We aimed to compare the incidences of antibody-mediated rejection (AMR) and acute cellular rejection (ACR) as well as graft and patient outcomes in KTRs who underwent induction with alemtuzumab versus rabbit-antithymocyte globulin (r-ATG). Methods This was a single-center retrospective study involving patients who underwent kidney transplantation between January 2009 and December 2011 after receiving induction therapy with either alemtuzumab or r-ATG. Maintenance immunosuppression included tacrolimus and mycophenolate mofetil with early steroid withdrawal. Acute rejection was diagnosed using allograft biopsy. Results Among the 108 study patients, 68 received alemtuzumab and 40 got r-ATG. There was a significantly higher incidence of AMR (15% vs 2.5%; P  = .008) and similar incidence of ACR (4.4% vs 10%; P  = .69) for alemtuzumab versus r-ATG groups. One-year serum creatinine levels (l.68 ± 0.8 mg/dL vs 1.79 ± 1.8 mg/dL; P  = .66) as well as graft (91.1 ± 3.5% vs 94.5 ± 3.8%; P  = .48) and patient (93.8 ± 3.0% vs 96.4 ± 3.5%; P  = .92) survivals were similar for the alemtuzumab versus the r-ATG groups. Conclusion Our study showed a higher incidence of AMR and similar incidence of ACR in KTRs who underwent induction with alemtuzumab compared with those who received r-ATG and were maintained on tacrolimus and MMF. This was despite a lower HLA mismatch in the alemtuzumab group. One-year graft survival, patient survival, and allograft function were similar. Inadequate B-cell suppression by alemtuzumab as well as altered phenotypic and functional properties of repopulating B cells could be contributing to heightened risk of AMR in these patients.