Comparison of Alemtuzumab and Anti-thymocyte Globulin Treatment for Acute Kidney Allograft Rejection

Abstract

Rabbit anti-thymocyte globulin (rATG) is currently the treatment of choice for glucocorticoid-resistant, recurrent, or severe acute allograft rejection (AR). However, rATG is associated with severe infusion-related side effects. Alemtuzumab is incidentally given to kidney transplant recipients as treatment for AR. In the current study, the outcomes of patients treated with alemtuzumab for AR were compared with that of patients treated with rATG for AR. The patient-, allograft-, and infection-free survival and adverse events of 116 alemtuzumab-treated patients were compared with those of 108 patients treated with rATG for AR. Propensity scores were used to control for differences between the two groups. Patient-and allograft survival of patients treated with either alemtuzumab or rATG were not different [hazard ratio (HR) 1.14, 95%-confidence interval (CI) 0.48-2.69, p = 0.77, and HR 0.82, 95%-CI 0.45-1.5, p = 0.52, respectively). Infection-free survival after alemtuzumab treatment was superior compared with that of rATG-treated patients (HR 0.41, 95%-CI 0.25-0.68, p < 0.002). Infusion-related adverse events occurred less frequently after alemtuzumab treatment. Alemtuzumab therapy may therefore be an alternative therapy for glucocorticoid-resistant, recurrent, or severe acute kidney transplant rejection.

Clinical and Molecular Profiling to Develop a Potential Prediction Model for the Response to Alemtuzumab Therapy for Acute Kidney Transplant Rejection

“…Alemtuzumab is the treatment of choice for severe or glucocorticoid‐resistant AR in the Erasmus MC since 2012. 6 , 7 For this retrospective cohort study, kidney transplant recipients who were treated with alemtuzumab for this indication were investigated. 7 Severe AR was defined as Banff grade IIA or higher.…”

“… 6 , 7 For this retrospective cohort study, kidney transplant recipients who were treated with alemtuzumab for this indication were investigated. 7 Severe AR was defined as Banff grade IIA or higher. Glucocorticoid‐resistant AR was defined as the absence of significant improvement in kidney function as judged by the treating physician.…”

“…All clinical characteristics listed in Table S1 were considered for inclusion in the prediction model based on clinical relevance to the outcome of interest, observations from an earlier publication studying the same cohort of patients, and literature review. 7 , 17 , 18 , 19 …”

“… 4 , 5 Alemtuzumab is also an effective therapy for severe or glucocorticoid‐resistant acute kidney transplant rejection. 6 , 7 For these indications, treatment with alemtuzumab compared with anti‐thymocyte globulin, results in comparable patient and allograft survival but fewer infusion‐related side effects. 2 , 5 , 6 , 7 …”

“… 6 , 7 For these indications, treatment with alemtuzumab compared with anti‐thymocyte globulin, results in comparable patient and allograft survival but fewer infusion‐related side effects. 2 , 5 , 6 , 7 …”