Alemtuzumab Induction in Deceased Donor Kidney Transplantation

Huang, Edmund; Cho, Yong W.; Hayashi, Rick; Bunnapradist, Suphamai

doi:10.1097/01.tp.0000281942.97406.89

Cited by 33 publications

(25 citation statements)

References 24 publications

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“…Several studies have compared the incidence rates of rejection and patient and graft-survival rates [12,13,16,18,[22][23][24][25] and use in African American and Hispanic populations [26] , but thus far few studies have looked into the efficacy and safety in the patient population over 65 years [11,14,15] . This is important, as the use of alemtuzumab has increased over the past decade in the United States and the fact that alemtuzumab is such an efficacious agent and its mechanism of depletion is so profound that it may take up to a year after administration for the immune system to regain full function.…”

Section: Discussionmentioning

confidence: 99%

Poor Outcomes in Elderly Kidney Transplant Recipients Receiving Alemtuzumab Induction

et al. 2011

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justing for baseline differences, induction with alemtuzumab was associated with an increased risk of graft loss and death, with an adjusted hazard ratio (AHR) of 1.26 (95% CI 1.08-1.48). Risk was also present at other age cutoffs [age 1 60 (AHR 1.16; 95% CI 1.03-1.31; p = 0.014), age 1 70 (AHR 1.43; 95% CI 1.13-1.81; p = 0.003) and age 1 75 (AHR 1.68; 95% CI 1.07-2.63; p = 0.024)]. Conclusions: In the elderly, alemtuzumab is associated with an escalating risk of death and graft loss in recipients of kidney transplantations.

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Section: Discussionmentioning

confidence: 99%

Poor Outcomes in Elderly Kidney Transplant Recipients Receiving Alemtuzumab Induction

et al. 2011

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“…In our overall analysis, alemtuzumab use was associated with a higher risk of acute rejection, all-cause graft loss, and death. Prior retrospective analyses of alemtuzumab use in younger living-and deceased-donor kidney transplant recipients have reported mixed results (23)(24)(25). Recently, a a Steroid use at discharge, CIT Ͼ36 hours, CIT unknown, DCD, PRA Ͼ 20%, PRA unknown, zero HLA mismatches, and dialysis duration unknown were NS (P Ͼ 0.10).…”

Section: Alemtuzumab In the Elderlymentioning

confidence: 99%

Induction Immunosuppressive Therapy in the Elderly Kidney Transplant Recipient in the United States

Gill¹,

Sampaio²,

Gill³

et al. 2011

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives The choice of induction agent in the elderly kidney transplant recipient is unclear. Results In high-risk recipients with high-risk donors there was a higher risk of rejection and functional graft loss with IL2RA versus rATG. Among low-risk recipients with low-risk donors there was no difference in outcomes between IL2RA and rATG. In the two groups in which donor or recipient was high risk, there was a higher risk of rejection but not functional graft loss with IL2RA. Among low-risk recipients with high-risk donors, there was a trend toward a higher risk of death with IL2RA.Conclusions rATG may be preferable in high-risk recipients with high-risk donors and possibly low-risk recipients with high-risk donors. In the remaining groups, although rATG is associated with a lower risk of acute rejection, long-term outcomes do not appear to differ. Prospective comparison of these agents in an elderly cohort is warranted to compare the efficacy and adverse consequences of these agents to refine the use of induction immunosuppressive therapy in the elderly population.

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“…Over the last decade, alemtuzumab (AZ) (Campath-1 H) has been used in kidney transplant immunosuppressive protocols at a number of centers (5)(6)(7)(8)(9)(10)(11)(12)(13)(14). Various single and multicenter studies, both randomized and nonrandomized, are reasonably consistent in demonstrating the effectiveness of AZ as an induction or preconditioning agent in renal transplant recipients usually in the context of steroid avoidance or early withdrawal.…”

Section: Introductionmentioning

confidence: 99%

Outcomes Associated with Steroid Avoidance and Alemtuzumab among Kidney Transplant Recipients

Serrano

Friedmann

Ahsanuddin

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives Alemtuzumab is a humanized anti-CD52 monoclonal antibody used as induction in kidney transplantation (KTX) since 2003. Few studies have evaluated long-term outcomes of this agent or changes in outcomes over time.Design, setting, participants, & measurements A retrospective cohort study was performed examining United States registry data from 2003 to 2014 of primary KTX recipients receiving induction with alemtuzumab (AZ; n=5521) or antithymocyte globulin (ATG; n=8504) and maintenance immunosuppression with tacrolimus and mycophenolate mofetil and early withdrawal of steroids. The primary outcome was overall death-censored graft survival (DCGS), and secondary outcomes were overall patient survival and 1-year acute rejection. Multivariate models were fit with donor, recipient, and transplant covariates. Because poorer outcomes with AZ may occur from a learning curve impact with the use of a new medication, transplant year was categorized into three time periods to evaluate outcomes over time (2003-2005, 2006-2008, $2009), and an interaction term of induction type with transplant year category was included in all models to test for era impacts.Results On multivariate analysis of DCGS there was a significant interaction between AZ and era (P,0.001). Risk-adjusted patient survival (aHR, 1.32; 95% CI, 1.08 to 1.61; aHR, 1.26; 95% CI, 1.09 to 1.46; and aHR, 1.10; 95% CI, 0.93 to 1.29 by era, respectively) and acute rejection (adjusted odds ratio [aOR], 1.17; 95% CI, 0.96 to 1.42; aOR, 0.94; 95% CI, 0.82 to 1.07; aOR, 0.89; 95% CI, 0.81 to 0.98 by era, respectively) with AZ was comparable with ATG in the most recent era; however, there was no significant interaction with time (P=0.13 and P=0.06, respectively).Conclusions Current alemtuzumab utilization is associated with comparable graft and patient survival and acute rejection compared with ATG. Graft survival with alemtuzumab has improved over time.

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Alemtuzumab Induction in Deceased Donor Kidney Transplantation

Cited by 33 publications

References 24 publications

Poor Outcomes in Elderly Kidney Transplant Recipients Receiving Alemtuzumab Induction

Poor Outcomes in Elderly Kidney Transplant Recipients Receiving Alemtuzumab Induction

Induction Immunosuppressive Therapy in the Elderly Kidney Transplant Recipient in the United States

Outcomes Associated with Steroid Avoidance and Alemtuzumab among Kidney Transplant Recipients

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