Living Donor Renal Transplantation Using Alemtuzumab Induction and Tacrolimus Monotherapy

• Published in: American journal of transplantation Vol. 6; no. 10; pp. 2409 - 2417
• Main Authors: Tan, H. P., Kaczorowski, D. J., Basu, A., Unruh, M., McCauley, J., Wu, C., Donaldson, J., Dvorchik, I., Kayler, L., Marcos, A., Randhawa, P., Smetanka, C., Starzl, T. E., Shapiro, R.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.10.2006; Blackwell
• Subjects: Acute cellular rejection; Adult; African American; Alemtuzumab; Antibodies, Monoclonal - therapeutic use; Antibodies, Monoclonal, Humanized; Antibodies, Neoplasm - therapeutic use; Antineoplastic Agents - therapeutic use; Biological and medical sciences; Campath‐1H; Cytomegalovirus; focal segmental glomerulosclerosis; Follow-Up Studies; Glomerulonephritis; Graft Rejection - epidemiology; Graft Rejection - prevention & control; Graft Survival; HIV; Human viral diseases; Humans; Immunosuppressive Agents - therapeutic use; Incidence; Infectious diseases; Kidney Transplantation; Living Donors; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; Prospective Studies; Severe acute respiratory syndrome-related coronavirus; steroid‐free; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Tacrolimus - therapeutic use; tacrolimus monotherapy; Treatment Outcome; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Glomerulonephritis; Graft(material); Calcineurin inhibitor; Campath-1H; Monoclonal antibody; Homotransplantation; Surgery; Treatment withdrawal; Immunotherapy; Graft; Protein synthesis inhibitor; Cell; Triggering; steroid-free; Acute cellular rejection; Kidney disease; Human; Immunopathology; Corticosteroid; Urinary system disease; Induction; Acute; Living donor; Retroviridae; Lactone; AIDS; Alemtuzumab; focal segmental glomerulosclerosis; tacrolimus monotherapy; Immune deficiency; Lentivirus; Macrolide; Infection; Virus; Immunomodulator; Rejection; Treatment; Urinary system; Tacrolimus; HIV; Viral disease; Nephrotic syndrome with focal glomerular sclerosis; Immunosuppressive agent; Human immunodeficiency virus; Antibacterial agent; Monotherapy; African American; Kidney transplantation
• ISSN: 1600-6135; 1600-6143
• DOI: 10.1111/j.1600-6143.2006.01495.x

Alemtuzumab was used as an induction agent in 205 renal transplant recipients undergoing 207 living donor renal transplants. All donor kidneys were recovered laparoscopically. Postoperatively, patients were treated with tacrolimus monotherapy, and immunosuppression was weaned when possible. Forty‐seven recipients of living donor renal transplants prior to the induction era who received conventional triple drug immunosuppression without antibody induction served as historic controls. The mean follow‐up was 493 days in the alemtuzumab group and 2101 days in the historic control group. Actuarial 1‐year patient and graft survival were 98.6% and 98.1% in the alemtuzumab group, compared to 93.6% and 91.5% in the control group, respectively. The incidence of acute cellular rejection (ACR) at 1 year was 6.8% in the alemtuzumab group and 17.0% (p < 0.05) in the historic control group. Most (81.3%) episodes of ACR in the alemtuzumab group were Banff 1 (a or b) and were sensitive to steroid pulses for the treatment of rejection. There was no cytomegalovirus disease or infection. The incidence of delayed graft function was 0%, and the incidence of posttransplant insulin‐dependent diabetes mellitus was 0.5%. This study represents the largest series to date of live donor renal transplant recipients undergoing alemtuzumab induction, and confirms the short‐term safety and efficacy of this approach. In 207 living donor renal transplants, alemtuzumab induction and tacrolimus monotherapy resulted in 98% graft survival, 7% incidence of rejection episodes, and no CMV disease. See also editorial by Kirk and Light in this issue on page 2228.