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

Harrison E. Saull, Cher Y. Enderby, Thomas A. Gonwa, Hani M. Wadei

Research output: Contribution to journalArticle

4 Citations (Scopus)

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<sup>2</sup>, 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.

Original languageEnglish (US)
Pages (from-to)573-580
Number of pages8
JournalClinical Transplantation
Volume29
Issue number7
DOIs
StatePublished - Jul 1 2015

Fingerprint

Antilymphocyte Serum
Steroids
Transplants
Kidney
Iothalamic Acid
Rabbits
Therapeutics
Glomerular Filtration Rate
Biopsy
Arm
BK Virus
Mycophenolic Acid
Confounding Factors (Epidemiology)
alemtuzumab
Viremia
Tacrolimus
Graft Survival
Kidney Transplantation
Immunosuppression
Creatinine

Keywords

  • Alemtuzumab
  • Antithymocyte globulin
  • Induction therapy
  • Rabbit antithymocyte globulin
  • Renal transplantation

ASJC Scopus subject areas

  • Transplantation

Cite this

Comparison of alemtuzumab vs. antithymocyte globulin induction therapy in primary non-sensitized renal transplant patients treated with rapid steroid withdrawal. / Saull, Harrison E.; Enderby, Cher Y.; Gonwa, Thomas A.; Wadei, Hani M.

In: Clinical Transplantation, Vol. 29, No. 7, 01.07.2015, p. 573-580.

Research output: Contribution to journalArticle

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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 m2, 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.",
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