TY - JOUR
T1 - Two hundred living donor kidney transplantations under alemtuzumab induction and tacrolimus monotherapy
T2 - 3-Year follow-up
AU - Tan, H. P.
AU - Donaldson, J.
AU - Basu, A.
AU - Unruh, M.
AU - Randhawa, P.
AU - Sharma, V.
AU - Morgan, C.
AU - McCauley, J.
AU - Wu, C.
AU - Shah, N.
AU - Zeevi, A.
AU - Shapiro, R.
PY - 2009/2
Y1 - 2009/2
N2 - 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 m2) 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 antibody-mediated rejection (AMR). About 76.5% were weaned but only 46% are currently on spaced dose (qod or less) tacrolimus monotherapy, and 94.4% remained steroid-free from the time of transplantation. Infectious complications were uncommon. This experience suggests the 3-year efficacy of this approach.
AB - 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 m2) 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 antibody-mediated rejection (AMR). About 76.5% were weaned but only 46% are currently on spaced dose (qod or less) tacrolimus monotherapy, and 94.4% remained steroid-free from the time of transplantation. Infectious complications were uncommon. This experience suggests the 3-year efficacy of this approach.
KW - Acute cellular rejection
KW - African American
KW - Antibody-mediated rejection
KW - Campath-1H
KW - Chronic allograft nephropathy
KW - Focal segmental glomerulosclerosis
KW - HIV
KW - Induction
KW - Interstitial fibrosis
KW - Laparoscopic live donor nephrectomy
KW - Pediatric
KW - Steroid avoidance
KW - Steroid free
KW - Tubular atrophy
UR - http://www.scopus.com/inward/record.url?scp=58849149853&partnerID=8YFLogxK
U2 - 10.1111/j.1600-6143.2008.02492.x
DO - 10.1111/j.1600-6143.2008.02492.x
M3 - Article
C2 - 19120078
AN - SCOPUS:58849149853
SN - 1600-6135
VL - 9
SP - 355
EP - 366
JO - American Journal of Transplantation
JF - American Journal of Transplantation
IS - 2
ER -