We analyzed our 10-year experience with Alemtuzumab (Campath-1H) induction and tacrolimus monotherapy for deceased donor kidney transplants (DDKT).

We performed 1025 consecutive unselected DDKT from 12/05/2002 to 10/26/2012 using 30 mg or 0.5mg/kg alemtuzumab and tacrolimus monotherapy. Tacrolimus was wean when possible (bid–>qd–>qod–>tiw–>biw–>qwk. However, spaced weaning was halted in Mar 2007. In Jan 2011, MMF (500mg bid) was routinely added to all recipients. The recipients included 5 HIV+ (0.5%), 49 (4.8%) pediatric recipients, 166 (16.2%) African American, 132 (12.9%) patients >70 yrs old, 101 (9.9%) patients with PRA>20%, and 210 (20.5%) re-transplants. HLA A, B, Dr mismatch was 3.8 ± 1.7. The mean follow up was 55.7±30.7 months.

Mean recipient age for adult and pediatric recipients was 55.0±13.6 and 12.4±4.7 years respectively. Actuarial recipient survivals at 1-, 2-, 3-, 4-, 5-, 6-, 7-, 8-, and 9-years were 94.9%, 90.5%, 86.0%, 80.6%, 76.5%, 71.5%, 69.3%, 67.9%, and 65.9%, respectively. Graft survivals at 1-, 2-, 3-, 4-, 5-, 6-, 7-, 8-, and 9-years were 88.5%, 82.4%, 75.6%, 67.8%, 61.6%, 57.4%, 55.7%, 52.7%, and 49.5% respectively. The mean GFR (mL/min/1.73m²) at 1-, 2-, 3-, 4-, 5-, 6-, 7-, 8-, and 9- years were 52±23, 51±23, 53±41, 50±24, 52±27, 51±24, 51±25, 53±30, and 56±28, respectively. The cumulative incidence of biopsy-proven acute cellular rejection (ACR) at 0.5-, 1-, 2-, 3-, 4-, 5-, 6-, 7-, 8-, 9-, and 10-years were 7.5%, 16.2%, 23.9%, 27.6%, 29.5%, 30.9%, 31.8%, 32.5%, 32.7%, 33.0%, and 33.0% respectively. Most ACR were Banff 1 and sensitive to steroid pulse. There were 15.8% (162) incidence of AMR and these patients underwent plasmapheresis and IVIg. Because no protocol biopsies were performed, we could not make any definitive conclusion in the limited IF/TA data. About 90% remain steroid free. With respect to viral infections, there were 3 (0.3%) cases of CMV disease, 27.4% underwent CMV seroconversion; 34.8% had BK viuria, 13.2% had BK viremia, 7.8% with BKVN.

The 10 year experience of Alemtuzumab (Campath-1H) pretreatment with tacrolimus monotherapy for DDKT reflects the high incidence of ACR the 1^st to 3^rd year post-transplant, partly contributing to lower graft survivals. We have stopped the weaning process in 2007 and routinely add MMF to all recipients.

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