Delayed allograft inflammation following alemtuzumab induction for kidney transplantation

Raymond L. Heilman, Hasan A. Khamash, Maxwell L. Smith, Harini M Chakkera, Adyr A. Moss, Kunam Sudhakar Reddy

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background: In a recent clinical trial in kidney transplant recipients, induction with alemtuzumab and rabbit-antithymocyte globulin (r-ATG) was equally effective in preventing rejection during the first post-transplant year; however, this study did not include protocol biopsies. Methods: The aim of this study was to analyze the impact of alemtuzumab induction on rejection and subclinical inflammation during the first post-transplant year compared with a historic control group receiving induction with r-ATG. All patients received tacrolimus and mycophenolate mofetil (MMF). Results: There were 361 in the alemtuzumab group and 478 in the r-ATG groups. Rejection (excluding Banff borderline), during the first year, occurred in 14% of the alemtuzumab group and 9% of the r-ATG group (p = 0.03). Estimated glomerular filtration rate (GFR) (chronic kidney disease (CKD)-EPI formula) at one yr and graft survival at three yr were similar. On the protocol biopsies, interstitial inflammation (Banff i scores) and tubulitis (Banff t scores) were more likely in the r-ATG group at one month, but at four and 12 months, both inflammation and tubulitis were more likely in the alemtuzumab group. Conclusions: We conclude that alemtuzumab induction is associated with delayed inflammation at four and 12 months, but this inflammation did not appear to negatively impact the GFR or graft survival.

Original languageEnglish (US)
Pages (from-to)772-780
Number of pages9
JournalClinical Transplantation
Volume27
Issue number5
DOIs
StatePublished - Sep 2013

Fingerprint

Antilymphocyte Serum
Kidney Transplantation
Allografts
Inflammation
Rabbits
Graft Survival
Glomerular Filtration Rate
Mycophenolic Acid
Transplants
Biopsy
Tacrolimus
Chronic Renal Insufficiency
alemtuzumab
Clinical Trials
Kidney
Control Groups

Keywords

  • Acute rejection
  • Alemtuzumab
  • Antithymocyte globulin
  • Induction
  • Kidney transplantation
  • Protocol biopsy

ASJC Scopus subject areas

  • Transplantation

Cite this

Delayed allograft inflammation following alemtuzumab induction for kidney transplantation. / Heilman, Raymond L.; Khamash, Hasan A.; Smith, Maxwell L.; Chakkera, Harini M; Moss, Adyr A.; Reddy, Kunam Sudhakar.

In: Clinical Transplantation, Vol. 27, No. 5, 09.2013, p. 772-780.

Research output: Contribution to journalArticle

Heilman, Raymond L. ; Khamash, Hasan A. ; Smith, Maxwell L. ; Chakkera, Harini M ; Moss, Adyr A. ; Reddy, Kunam Sudhakar. / Delayed allograft inflammation following alemtuzumab induction for kidney transplantation. In: Clinical Transplantation. 2013 ; Vol. 27, No. 5. pp. 772-780.
@article{c4a680d717114532b4424107db874dc8,
title = "Delayed allograft inflammation following alemtuzumab induction for kidney transplantation",
abstract = "Background: In a recent clinical trial in kidney transplant recipients, induction with alemtuzumab and rabbit-antithymocyte globulin (r-ATG) was equally effective in preventing rejection during the first post-transplant year; however, this study did not include protocol biopsies. Methods: The aim of this study was to analyze the impact of alemtuzumab induction on rejection and subclinical inflammation during the first post-transplant year compared with a historic control group receiving induction with r-ATG. All patients received tacrolimus and mycophenolate mofetil (MMF). Results: There were 361 in the alemtuzumab group and 478 in the r-ATG groups. Rejection (excluding Banff borderline), during the first year, occurred in 14{\%} of the alemtuzumab group and 9{\%} of the r-ATG group (p = 0.03). Estimated glomerular filtration rate (GFR) (chronic kidney disease (CKD)-EPI formula) at one yr and graft survival at three yr were similar. On the protocol biopsies, interstitial inflammation (Banff i scores) and tubulitis (Banff t scores) were more likely in the r-ATG group at one month, but at four and 12 months, both inflammation and tubulitis were more likely in the alemtuzumab group. Conclusions: We conclude that alemtuzumab induction is associated with delayed inflammation at four and 12 months, but this inflammation did not appear to negatively impact the GFR or graft survival.",
keywords = "Acute rejection, Alemtuzumab, Antithymocyte globulin, Induction, Kidney transplantation, Protocol biopsy",
author = "Heilman, {Raymond L.} and Khamash, {Hasan A.} and Smith, {Maxwell L.} and Chakkera, {Harini M} and Moss, {Adyr A.} and Reddy, {Kunam Sudhakar}",
year = "2013",
month = "9",
doi = "10.1111/ctr.12201",
language = "English (US)",
volume = "27",
pages = "772--780",
journal = "Clinical Transplantation",
issn = "0902-0063",
publisher = "Wiley-Blackwell",
number = "5",

}

TY - JOUR

T1 - Delayed allograft inflammation following alemtuzumab induction for kidney transplantation

AU - Heilman, Raymond L.

AU - Khamash, Hasan A.

AU - Smith, Maxwell L.

AU - Chakkera, Harini M

AU - Moss, Adyr A.

AU - Reddy, Kunam Sudhakar

PY - 2013/9

Y1 - 2013/9

N2 - Background: In a recent clinical trial in kidney transplant recipients, induction with alemtuzumab and rabbit-antithymocyte globulin (r-ATG) was equally effective in preventing rejection during the first post-transplant year; however, this study did not include protocol biopsies. Methods: The aim of this study was to analyze the impact of alemtuzumab induction on rejection and subclinical inflammation during the first post-transplant year compared with a historic control group receiving induction with r-ATG. All patients received tacrolimus and mycophenolate mofetil (MMF). Results: There were 361 in the alemtuzumab group and 478 in the r-ATG groups. Rejection (excluding Banff borderline), during the first year, occurred in 14% of the alemtuzumab group and 9% of the r-ATG group (p = 0.03). Estimated glomerular filtration rate (GFR) (chronic kidney disease (CKD)-EPI formula) at one yr and graft survival at three yr were similar. On the protocol biopsies, interstitial inflammation (Banff i scores) and tubulitis (Banff t scores) were more likely in the r-ATG group at one month, but at four and 12 months, both inflammation and tubulitis were more likely in the alemtuzumab group. Conclusions: We conclude that alemtuzumab induction is associated with delayed inflammation at four and 12 months, but this inflammation did not appear to negatively impact the GFR or graft survival.

AB - Background: In a recent clinical trial in kidney transplant recipients, induction with alemtuzumab and rabbit-antithymocyte globulin (r-ATG) was equally effective in preventing rejection during the first post-transplant year; however, this study did not include protocol biopsies. Methods: The aim of this study was to analyze the impact of alemtuzumab induction on rejection and subclinical inflammation during the first post-transplant year compared with a historic control group receiving induction with r-ATG. All patients received tacrolimus and mycophenolate mofetil (MMF). Results: There were 361 in the alemtuzumab group and 478 in the r-ATG groups. Rejection (excluding Banff borderline), during the first year, occurred in 14% of the alemtuzumab group and 9% of the r-ATG group (p = 0.03). Estimated glomerular filtration rate (GFR) (chronic kidney disease (CKD)-EPI formula) at one yr and graft survival at three yr were similar. On the protocol biopsies, interstitial inflammation (Banff i scores) and tubulitis (Banff t scores) were more likely in the r-ATG group at one month, but at four and 12 months, both inflammation and tubulitis were more likely in the alemtuzumab group. Conclusions: We conclude that alemtuzumab induction is associated with delayed inflammation at four and 12 months, but this inflammation did not appear to negatively impact the GFR or graft survival.

KW - Acute rejection

KW - Alemtuzumab

KW - Antithymocyte globulin

KW - Induction

KW - Kidney transplantation

KW - Protocol biopsy

UR - http://www.scopus.com/inward/record.url?scp=84884977725&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84884977725&partnerID=8YFLogxK

U2 - 10.1111/ctr.12201

DO - 10.1111/ctr.12201

M3 - Article

C2 - 23924146

AN - SCOPUS:84884977725

VL - 27

SP - 772

EP - 780

JO - Clinical Transplantation

JF - Clinical Transplantation

SN - 0902-0063

IS - 5

ER -