Alemtuzumab induction and antibody-mediated kidney rejection after simultaneous pancreas-kidney transplantation

Julio Pascual, John D. Pirsch, Jon S. Odorico, José R. Torrealba, Arjang Djamali, Yolanda T. Becker, Barbara Voss, Glen E. Leverson, Stuart J. Knechtle, Hans W. Sollinger, Milagros D. Samaniego-Picota

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

Background.: The best induction agent for simultaneous pancreas-kidney transplantation (SPKT) remains the subject of debate. Alemtuzumab is effective in preventing acute cellular rejection (ACR) in SPK recipients and has been used to prevent antibody-mediated rejection (AMR) in sensitized kidney transplant candidates. Methods.: A retrospective cohort study was performed including 136 SPK recipients receiving maintenance immunosuppression with tacrolimus, mycophenolic acid prodrugs, and prednisone. Two groups were compared: those who received induction with alemtuzumab (n=97) and those induced with basiliximab (n=39). Results.: Kidney ACR was more frequent in SPKT induced with basiliximab (2-year 12.8% vs. 3.1%, P=0.04), but the incidence of AMR was similar (2-year 18% with basiliximab vs. 13.8% with alemtuzumab, P=NS). Kidney rejection was associated with clinical pancreas rejection in 70% of cases, without differences between the groups. Postrejection kidney graft survival was similar in both groups (2-year basiliximab/alemtuzumab 94.7%/91.2%), but death-censored kidney graft survival was lower with alemtuzumab (100%/91.2%, P=0.056). In the basiliximab group, the predominant cause of kidney loss was death-with-function, whereas in the alemtuzumab group AMR accounted for all losses. Pancreas graft survival was similar in both groups, yet more pancreas losses due to acute rejection occurred in alemtuzumab-treated patients (4 vs. 1). Conclusions.: Kidney AMR is more common than ACR in SPKT recipients treated with alemtuzumab, tacrolimus, mycophenolic acid, and steroids. ACR is better prevented by alemtuzumab than basiliximab, but no relevant difference is found in prevention of AMR. Despite the high incidence of AMR, survival rates are excellent in both groups.

Original languageEnglish (US)
Pages (from-to)125-132
Number of pages8
JournalTransplantation
Volume87
Issue number1
DOIs
StatePublished - Jan 15 2009

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Pancreas Transplantation
Kidney Transplantation
Kidney
Antibodies
Graft Survival
Mycophenolic Acid
Pancreas
Tacrolimus
alemtuzumab
Incidence
Prodrugs
Prednisone
Immunosuppression
basiliximab
Cohort Studies
Survival Rate
Retrospective Studies
Steroids
Maintenance
Transplants

Keywords

  • Anti-CD25 monoclonal antibody
  • B-cell
  • Campath-1H
  • Induction therapy
  • Kidney transplantation

ASJC Scopus subject areas

  • Transplantation

Cite this

Pascual, J., Pirsch, J. D., Odorico, J. S., Torrealba, J. R., Djamali, A., Becker, Y. T., ... Samaniego-Picota, M. D. (2009). Alemtuzumab induction and antibody-mediated kidney rejection after simultaneous pancreas-kidney transplantation. Transplantation, 87(1), 125-132. https://doi.org/10.1097/TP.0b013e31818c6db0

Alemtuzumab induction and antibody-mediated kidney rejection after simultaneous pancreas-kidney transplantation. / Pascual, Julio; Pirsch, John D.; Odorico, Jon S.; Torrealba, José R.; Djamali, Arjang; Becker, Yolanda T.; Voss, Barbara; Leverson, Glen E.; Knechtle, Stuart J.; Sollinger, Hans W.; Samaniego-Picota, Milagros D.

In: Transplantation, Vol. 87, No. 1, 15.01.2009, p. 125-132.

Research output: Contribution to journalArticle

Pascual, J, Pirsch, JD, Odorico, JS, Torrealba, JR, Djamali, A, Becker, YT, Voss, B, Leverson, GE, Knechtle, SJ, Sollinger, HW & Samaniego-Picota, MD 2009, 'Alemtuzumab induction and antibody-mediated kidney rejection after simultaneous pancreas-kidney transplantation', Transplantation, vol. 87, no. 1, pp. 125-132. https://doi.org/10.1097/TP.0b013e31818c6db0
Pascual, Julio ; Pirsch, John D. ; Odorico, Jon S. ; Torrealba, José R. ; Djamali, Arjang ; Becker, Yolanda T. ; Voss, Barbara ; Leverson, Glen E. ; Knechtle, Stuart J. ; Sollinger, Hans W. ; Samaniego-Picota, Milagros D. / Alemtuzumab induction and antibody-mediated kidney rejection after simultaneous pancreas-kidney transplantation. In: Transplantation. 2009 ; Vol. 87, No. 1. pp. 125-132.
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abstract = "Background.: The best induction agent for simultaneous pancreas-kidney transplantation (SPKT) remains the subject of debate. Alemtuzumab is effective in preventing acute cellular rejection (ACR) in SPK recipients and has been used to prevent antibody-mediated rejection (AMR) in sensitized kidney transplant candidates. Methods.: A retrospective cohort study was performed including 136 SPK recipients receiving maintenance immunosuppression with tacrolimus, mycophenolic acid prodrugs, and prednisone. Two groups were compared: those who received induction with alemtuzumab (n=97) and those induced with basiliximab (n=39). Results.: Kidney ACR was more frequent in SPKT induced with basiliximab (2-year 12.8{\%} vs. 3.1{\%}, P=0.04), but the incidence of AMR was similar (2-year 18{\%} with basiliximab vs. 13.8{\%} with alemtuzumab, P=NS). Kidney rejection was associated with clinical pancreas rejection in 70{\%} of cases, without differences between the groups. Postrejection kidney graft survival was similar in both groups (2-year basiliximab/alemtuzumab 94.7{\%}/91.2{\%}), but death-censored kidney graft survival was lower with alemtuzumab (100{\%}/91.2{\%}, P=0.056). In the basiliximab group, the predominant cause of kidney loss was death-with-function, whereas in the alemtuzumab group AMR accounted for all losses. Pancreas graft survival was similar in both groups, yet more pancreas losses due to acute rejection occurred in alemtuzumab-treated patients (4 vs. 1). Conclusions.: Kidney AMR is more common than ACR in SPKT recipients treated with alemtuzumab, tacrolimus, mycophenolic acid, and steroids. ACR is better prevented by alemtuzumab than basiliximab, but no relevant difference is found in prevention of AMR. Despite the high incidence of AMR, survival rates are excellent in both groups.",
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AU - Pirsch, John D.

AU - Odorico, Jon S.

AU - Torrealba, José R.

AU - Djamali, Arjang

AU - Becker, Yolanda T.

AU - Voss, Barbara

AU - Leverson, Glen E.

AU - Knechtle, Stuart J.

AU - Sollinger, Hans W.

AU - Samaniego-Picota, Milagros D.

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N2 - Background.: The best induction agent for simultaneous pancreas-kidney transplantation (SPKT) remains the subject of debate. Alemtuzumab is effective in preventing acute cellular rejection (ACR) in SPK recipients and has been used to prevent antibody-mediated rejection (AMR) in sensitized kidney transplant candidates. Methods.: A retrospective cohort study was performed including 136 SPK recipients receiving maintenance immunosuppression with tacrolimus, mycophenolic acid prodrugs, and prednisone. Two groups were compared: those who received induction with alemtuzumab (n=97) and those induced with basiliximab (n=39). Results.: Kidney ACR was more frequent in SPKT induced with basiliximab (2-year 12.8% vs. 3.1%, P=0.04), but the incidence of AMR was similar (2-year 18% with basiliximab vs. 13.8% with alemtuzumab, P=NS). Kidney rejection was associated with clinical pancreas rejection in 70% of cases, without differences between the groups. Postrejection kidney graft survival was similar in both groups (2-year basiliximab/alemtuzumab 94.7%/91.2%), but death-censored kidney graft survival was lower with alemtuzumab (100%/91.2%, P=0.056). In the basiliximab group, the predominant cause of kidney loss was death-with-function, whereas in the alemtuzumab group AMR accounted for all losses. Pancreas graft survival was similar in both groups, yet more pancreas losses due to acute rejection occurred in alemtuzumab-treated patients (4 vs. 1). Conclusions.: Kidney AMR is more common than ACR in SPKT recipients treated with alemtuzumab, tacrolimus, mycophenolic acid, and steroids. ACR is better prevented by alemtuzumab than basiliximab, but no relevant difference is found in prevention of AMR. Despite the high incidence of AMR, survival rates are excellent in both groups.

AB - Background.: The best induction agent for simultaneous pancreas-kidney transplantation (SPKT) remains the subject of debate. Alemtuzumab is effective in preventing acute cellular rejection (ACR) in SPK recipients and has been used to prevent antibody-mediated rejection (AMR) in sensitized kidney transplant candidates. Methods.: A retrospective cohort study was performed including 136 SPK recipients receiving maintenance immunosuppression with tacrolimus, mycophenolic acid prodrugs, and prednisone. Two groups were compared: those who received induction with alemtuzumab (n=97) and those induced with basiliximab (n=39). Results.: Kidney ACR was more frequent in SPKT induced with basiliximab (2-year 12.8% vs. 3.1%, P=0.04), but the incidence of AMR was similar (2-year 18% with basiliximab vs. 13.8% with alemtuzumab, P=NS). Kidney rejection was associated with clinical pancreas rejection in 70% of cases, without differences between the groups. Postrejection kidney graft survival was similar in both groups (2-year basiliximab/alemtuzumab 94.7%/91.2%), but death-censored kidney graft survival was lower with alemtuzumab (100%/91.2%, P=0.056). In the basiliximab group, the predominant cause of kidney loss was death-with-function, whereas in the alemtuzumab group AMR accounted for all losses. Pancreas graft survival was similar in both groups, yet more pancreas losses due to acute rejection occurred in alemtuzumab-treated patients (4 vs. 1). Conclusions.: Kidney AMR is more common than ACR in SPKT recipients treated with alemtuzumab, tacrolimus, mycophenolic acid, and steroids. ACR is better prevented by alemtuzumab than basiliximab, but no relevant difference is found in prevention of AMR. Despite the high incidence of AMR, survival rates are excellent in both groups.

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