Alemtuzumab (Alem) has been used as an induction agent in renal transplantation, frequently in regimens that minimize one of the other immunosuppressive agents. Purpose: To examine the frequency of leucopenia and infections with Alem compared to other induction therapy, when used with calcineurin inhibitor, mycophenolate and prednisone as maintenance therapy. Methods: This was a retrospective study that analyzed first year post transplant outcomes comparing patients that received Alem (n=30) for induction with 2 comparator groups that received either an IL-2 receptor antagonist (IL-2a) or Thymoglobulin (Thymo) (n= 60 for both groups); subjects in the comparator groups were matched 2:1 for age and type of donor to subjects in Alem. All patients received CMV prophylaxis unless serologies for donor and recipient were negative; blood for BK virus PCR was obtained at months 1,2,3,6,9, and 12. Maintenance immunosuppression in all groups consisted of tacrolimus, mycophenolate, and prednisone. G-CSF was given for an absolute neutrophil count < 500. Results: There were no differences in demographics between the 3 groups. Biopsy proven rejection occurred in 8% Alem, 13% IL-2A, and 2% Thymo (p=.057). Tacrolimus trough levels and prednisone doses were not different between the 3 groups at any time point. Mycophenolate dose was significantly lower in Alem at all time points (p<.02). White blood cell counts less than 2,000 were significantly more frequent in Alem vs IL-2A or Thymo (50%, 10%, 20%, p<.001). Use of G-CSF for neutropenia was significantly higher in Alem vs IL-2A or Thymo (43%, 8%, 10%, p<.001); more patients in Alem got 3 or more doses of G-CSF (p<.01). There was no difference in bacterial infections between the three groups. An increased incidence of EBV and adenoviral infections were seen in the Alem group (p<.05). Patients with more than 1 opportunistic viral infection (CMV, EBV, BK, Adenovirus) were significantly more frequent in Alem vs IL-2 or Thymo (13%, 2%, 0%, p<.01). Alem patients were viremic for a significantly longer period of time compared to the other 2 groups (p=.008). Conclusion: Alem had significantly more leucopenia that required G-CSF therapy compared to the other induction agents. Alem also significantly increased the viral disease burden by increasing the time patients were viremic and by increasing the number of patients with more than one opportunistic viral infection.

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