Alemtuzumab with rapid steroid taper in simultaneous kidney and pancreas transplantation: comparison to induction with antithymocyte globulin
| Autor: | Marek J. Mazur, D. Post, Harini M Chakkera, K. Hamawi, Raymond L. Heilman, Y. Devarapalli, Kunam S. Reddy, Kristin L. Mekeel, Adyr A. Moss, David C. Mulligan |
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| Rok vydání: | 2010 |
| Předmět: |
Graft Rejection
medicine.medical_specialty medicine.drug_class Antibodies Neoplasm medicine.medical_treatment Urology Renal function Pancreas transplantation Antibodies Monoclonal Humanized Mycophenolic acid Adrenal Cortex Hormones medicine Humans Alemtuzumab Kidney transplantation Antilymphocyte Serum Retrospective Studies Transplantation business.industry Patient Selection Graft Survival Antibodies Monoclonal Immunosuppression Mycophenolic Acid medicine.disease Kidney Transplantation Tacrolimus Surgery Creatinine Acute Disease Corticosteroid Drug Therapy Combination Pancreas Transplantation business Immunosuppressive Agents medicine.drug Glomerular Filtration Rate |
| Zdroj: | Transplantation proceedings. 42(6) |
| ISSN: | 1873-2623 |
| Popis: | We compared our experience with alemtuzumab induction and rapid steroid taper (RST) in simultaneous kidney and pancreas transplantation (SKPT) with a historic control group who received rabbit antithymocyte globulin (r-ATG) induction with RST. 74 SKPTs performed at our center between January 2005 to November 2008 who underwent immunosuppression with RST in combination with r-ATG induction (n = 33; 1.5 mg/kg x 4 for a total dose of 6 mg/kg) or alemtuzumab induction (n = 41; 30 mg single dose). Maintenance immunosuppression consisted of tacrolimus and mycophenolate mofetil. Steroids were discontinued after postoperative day 4. Recipient and transplant characteristics were similar between the 2 groups, with 82% of the r-ATG and 80% of the alemtuzumab group steroid free at 1 year. The rate of clinical acute rejection episodes was 12% in the r-ATG group and 15% in the alemtuzumab group. The rates of cytomegalovirus (CMV) infection, BK nephropathy, and graft survival were similar between the 2 groups. There was no difference in mean serum creatinine, calculated GFR, or fasting blood sugar at 1 year between the 2 groups, whereas glycosylated hemoglobin (HbA1c) was lower at 1 year in the alemtuzumab (5.3 +/- 0.4) versus the r-ATG group (5.6 +/- 0.4; P = .0021). Induction with r-ATG or alemtuzumab with RST was safe and effective in SKPT. The incidences of acute rejection episodes, CMV infection, and BK nephropathy were similar. Mean HbA1C at 1 year was lower among the alemtuzumab group. Further long-term follow-up is needed to confirm these results. |
| Databáze: | OpenAIRE |
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