Early and limited use of tacrolimus to avoid rejection in an alemtuzumab and sirolimus regimen for kidney transplantation: Clinical results and immune monitoring

S. J. Knechtle, J. Pascual, D. D. Bloom, J. R. Torrealba, E. Jankowska-Gan, W. J. Burlingham, J. Kwun, R. B. Colvin, V. Seyfert-Margolis, K. Bourcier, H. W. Sollinger

Research output: Contribution to journalArticle

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Abstract

Alemtuzumab induction with 60 days of tacrolimus treatment and continuous sirolimus treatment prevented acute rejection in nine of 10 consecutive renal allograft recipients. All patients are alive with a functioning kidney graft at 27-39 months of follow-up. Extensive immune monitoring was performed in all patients. Alloantibody detection, cytokine kinetics assay (CKA), and trans vivo delayed-type hypersensitivity (DTH) assay were performed every 6 months showing correlation with clinical evolution. Despite alloantibody presence in five patients, eight patients remain without the need for specific treatment and only sirolimus monotherapy in decreasing dosage. Four patients take only 1 mg sirolimus daily with levels of 3-4 ng/mL. One patient showed clinical signs of rejection at month 9 post-transplant, with slow increase in serum creatinine and histological signs of mixed cellular (endarteritis) and humoral rejection (C4d positivity in peritubular capillaries and donor-specific antibody (DSA)). In summary, the addition of tacrolimus therapy for 2 months to a steroid-free, alemtuzumab induction and sirolimus maintenance protocol limited the previously shown acute rejection development. Nevertheless, alloantibody was present in serum and/or C4d present on 1-year biopsy in half the patients. The combination of CKA and DSA monitoring or the performance of transvivo DTH correlated with immune status of the patients.

Original languageEnglish (US)
Pages (from-to)1087-1098
Number of pages12
JournalAmerican Journal of Transplantation
Volume9
Issue number5
DOIs
StatePublished - May 2009

Fingerprint

Immunologic Monitoring
Tacrolimus
Sirolimus
Kidney Transplantation
Isoantibodies
Delayed Hypersensitivity
Endarteritis
Tissue Donors
Cytokines
Transplants
Kidney
alemtuzumab
Antibodies
Therapeutics
Serum
Allografts
Creatinine
Steroids
Maintenance
Biopsy

Keywords

  • Alemtuzumab
  • Immune monitoring
  • Immunosuppression
  • Kidney
  • Transplantation

ASJC Scopus subject areas

  • Transplantation
  • Immunology and Allergy
  • Pharmacology (medical)

Cite this

Early and limited use of tacrolimus to avoid rejection in an alemtuzumab and sirolimus regimen for kidney transplantation : Clinical results and immune monitoring. / Knechtle, S. J.; Pascual, J.; Bloom, D. D.; Torrealba, J. R.; Jankowska-Gan, E.; Burlingham, W. J.; Kwun, J.; Colvin, R. B.; Seyfert-Margolis, V.; Bourcier, K.; Sollinger, H. W.

In: American Journal of Transplantation, Vol. 9, No. 5, 05.2009, p. 1087-1098.

Research output: Contribution to journalArticle

Knechtle, SJ, Pascual, J, Bloom, DD, Torrealba, JR, Jankowska-Gan, E, Burlingham, WJ, Kwun, J, Colvin, RB, Seyfert-Margolis, V, Bourcier, K & Sollinger, HW 2009, 'Early and limited use of tacrolimus to avoid rejection in an alemtuzumab and sirolimus regimen for kidney transplantation: Clinical results and immune monitoring', American Journal of Transplantation, vol. 9, no. 5, pp. 1087-1098. https://doi.org/10.1111/j.1600-6143.2009.02581.x
Knechtle, S. J. ; Pascual, J. ; Bloom, D. D. ; Torrealba, J. R. ; Jankowska-Gan, E. ; Burlingham, W. J. ; Kwun, J. ; Colvin, R. B. ; Seyfert-Margolis, V. ; Bourcier, K. ; Sollinger, H. W. / Early and limited use of tacrolimus to avoid rejection in an alemtuzumab and sirolimus regimen for kidney transplantation : Clinical results and immune monitoring. In: American Journal of Transplantation. 2009 ; Vol. 9, No. 5. pp. 1087-1098.
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AU - Pascual, J.

AU - Bloom, D. D.

AU - Torrealba, J. R.

AU - Jankowska-Gan, E.

AU - Burlingham, W. J.

AU - Kwun, J.

AU - Colvin, R. B.

AU - Seyfert-Margolis, V.

AU - Bourcier, K.

AU - Sollinger, H. W.

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