Delayed allograft inflammation following alemtuzumab induction for kidney transplantation. (8th August 2013)

• Record Type: Journal Article
• Authors: Heilman, Raymond L.; Khamash, Hasan A.; Smith, Maxwell L.; Chakkera, Harini A.; Moss, Adyr A.; Reddy, Kunam S.
• Is Part Of: Clinical transplantation. Volume 27:Number 5(2013:Sep./Oct.)
• Page Start: 772
• Page End: 780
• Publication Date: 2013-08-08
• Subjects: Transplantation of organs, tissues, etc -- Periodicals; 617.95
• DOI: 10.1111/ctr.12201
• Languages: English
• ISSNs: 0902-0063

Abstract

<abstract abstract-type="main" id="ctr12201-abs-0001"> <title>Abstract</title> <sec id="ctr12201-sec-0001" sec-type="section"> <title>Background</title> <p>In a recent clinical trial in kidney transplant recipients, induction with alemtuzumab and rabbit‐antithymocyte globulin (r‐ATG) was equally effective in preventing rejection during the first post‐transplant year; however, this study did not include protocol biopsies.</p> </sec> <sec id="ctr12201-sec-0002" sec-type="section"> <title>Methods</title> <p>The aim of this study was to analyze the impact of alemtuzumab induction on rejection and subclinical inflammation during the first post‐transplant year compared with a historic control group receiving induction with r‐ATG. All patients received tacrolimus and mycophenolate mofetil (MMF).</p> </sec> <sec id="ctr12201-sec-0003" sec-type="section"> <title>Results</title> <p>There were 361 in the alemtuzumab group and 478 in the r‐ATG groups. Rejection (excluding Banff borderline), during the first year, occurred in 14% of the alemtuzumab group and 9% of the r‐ATG group (p = 0.03). Estimated glomerular filtration rate (GFR) (chronic kidney disease (CKD)‐EPI formula) at one yr and graft survival at three yr were similar. On the protocol biopsies, interstitial inflammation (Banff i scores) and tubulitis (Banff t scores) were more likely in the r‐ATG group at one month, but at four and 12 months, both inflammation and tubulitis were more likely in the alemtuzumab group.</p> </sec> <sec id="ctr12201-sec-0004" sec-type="section"> <title>Conclusions</title> <p>We conclude that alemtuzumab induction is associated with delayed inflammation at four and 12 months, but this inflammation did not appear to negatively impact the GFR or graft survival.</p> </sec> </abstract>