Comparison of alemtuzumab vs. antithymocyte globulin induction therapy in primary non‐sensitized renal transplant patients treated with rapid steroid withdrawal

Abstract

Alemtuzumab and rabbit antithymocyte globulin (rATG) are commonly used for induction therapy in renal transplantation. This retrospective, single-center, cohort study evaluated cumulative incidence of one-yr biopsy-proven acute rejection (BPAR) among 200 consecutive primary non-sensitized kidney transplant recipients who received either alemtuzumab (n = 100) or rATG (n = 100) induction followed by rapid steroid taper, tacrolimus, and mycophenolate mofetil. Protocol biopsies, plasma and urine BK virus PCR, serum creatinine and iothalamate glomerular filtration rate (iGFR), were obtained at 1, 4, and 12 months from transplantation. The one-yr BPAR rates were similar between the alemtuzumab and rATG groups; however, rejection Banff IA and higher was more common in the alemtuzumab arm (18% vs. 5%, p = 0.047). After adjusting for confounding variables, alemtuzumab was still associated with Banff IA and higher rejection (adjusted OR: 3.7, CI: 1.2-10.5, p = 0.02). Despite similar rates of BK viremia, more patients in the alemtuzumab arm developed BK nephropathy (16% vs. 3%, p = 0.046). One-year iGFR (53.4 ± 20.2 vs. 71.9 ± 27.2 mL/min/1.73 m(2), p = 0.002) and three-yr graft survival (89.5% vs. 95%, p = 0.05) were lower in the alemtuzumab group. In low immunological risk kidney transplant recipients on steroid-free immunosuppression, alemtuzumab was associated with more severe rejection and BK nephropathy compared to rATG.

Defining a Steroid Withdrawal Protocol in a newly established Kidney Transplantation Unit

“…high immunological risk studies, the AR rates were moderate at 13-14% with a remarkably improved graft and patient survival being recorded. However, there is still need for further verifi cation on the consistence of this type of management protocol [44][45][46][47].…”

Defining a Steroid Withdrawal Protocol in a newly established Kidney Transplantation Unit

“…Information high immunological risk studies, the AR rates were moderate at 13-14% with a remarkably improved graft and patient survival being recorded. However, there is still need for further verifi cation on the consistence of this type of management protocol [44][45][46][47].…”

“…Incidence of biopsy-proven acute rejection (BPAR) in 852 unselected kidney transplant patients randomized to alemtuzumab induction with lowexposure tacrolimus, low-dose mycophenolic acid and no steroids, or to basiliximab induction with standard tacrolimus, standard mycophenolic acid and standard steroids. HR, hazard ratio; CI, confi dence interval[45].2(1): 030-040.…”

A Critical Review of Steroid Immunotherapy in Kidney Transplantation

“…Due to superior efficacy, anti-thymocyte globulin (ATG) is often preferred in high risk patients. Compared with alemtuzumab, it is associated with lower rate of AR, and a longer duration of allograft survival [9,10]. Non-depleting monoclonal antibody (basiliximab, an IL-2 receptor agonist) has a wider therapeutic window and is therefore the treatment of choice in low risk recipients [11,12].…”