Alemtuzumab in Renal Retransplantation – Transplant Outcomes and Associated Infections

Harris, Taylor N.; Szempruch, Kristen R.; Dupuis, Robert E.; Rodríguez, P.; Toledo, Alexander H.

doi:10.1016/j.transproceed.2021.08.056

Cited by 1 publication

(2 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The 3C study demonstrated that alemtuzumab induction followed by CNI and MMF minimization and steroid avoidance compared with basiliximab induction was associated with a decrease in acute rejection in the first 6 months after transplantation, primarily because of a significant decreased incidence of cellular rejection, but not of humoral rejection 40 . Use of alemtuzumab as induction therapy has also been associated with a higher incidence of dnDSA formation, although this was not corroborated in a more recent study 41,42 . In our study, dnDSA rate was increased in MSC patients, but not in controls, suggesting that the increased dnDSA occurrence must be primarily seen in the context of tacrolimus withdrawal and is not primarily correlated to alemtuzumab induction.…”

Section: Discussioncontrasting

confidence: 96%

“…40 Use of alemtuzumab as induction therapy has also been associated with a higher incidence of dnDSA formation, although this was not corroborated in a more recent study. 41,42 In our study, dnDSA rate was increased in MSC patients, but not in controls, suggesting that the increased dnDSA occurrence must be primarily seen in the context of tacrolimus withdrawal and is not primarily correlated to alemtuzumab induction.…”

Section: Discussionmentioning

confidence: 52%

See 1 more Smart Citation

HLA‐DQ eplet mismatch load may identify kidney transplant patients eligible for tacrolimus withdrawal without donor‐specific antibody formation after mesenchymal stromal cell therapy

Bezstarosti

Meziyerh

Reinders

et al. 2023

HLA

View full text Add to dashboard Cite

Recently, the randomized phase‐II Triton study demonstrated that mesenchymal stromal cell (MSC) therapy facilitated early tacrolimus withdrawal in living donor kidney transplant recipients. The current sub‐study analyzed formation of de novo donor‐specific HLA antibodies (dnDSA) in the context of the degree of HLA eplet mismatches. At the time of protocol biopsy at 6 months, 7/29 patients (24%) in the MSC group and 1/27 patient (3.7%) in the control group had developed dnDSA. In the MSC group, all dnDSA were anti‐HLA‐DQ; two patients had anti‐DQ alone and five patients combined with anti‐class I, HLA‐DR or ‐DP. Despite excess dnDSA formation in the MSC‐arm of the study, the evolution of eGFR (CKD‐EPI) and proteinuria were comparable 2 years posttransplant. All dnDSA were complement‐binding and three patients had antibody‐mediated rejection in the protocol biopsy, but overall rejection episodes were not increased. Everolimus had to be discontinued in nine patients because of toxicity, and tacrolimus was reintroduced in six patients because of dnDSA formation. The HLA‐DQ eplet mismatch load independently associated with dnDSA (adjusted hazard ratio = 1.07 per eplet mismatch, p = 0.008). A threshold of ≥11 HLA‐DQ eplet mismatches predicted subsequent dnDSA in all 11 patients in the MSC group, but specificity was low (44%). Further research is warranted to explore HLA molecular mismatch load as a biomarker to guide personalized maintenance immunosuppression in kidney transplantation.

show abstract

Section: Discussioncontrasting

confidence: 96%