1025 Deceased Donor Kidney Transplants Using Alemtuzumab Pretreatment and Tacrolimus Monotherapy: 10 Year Experience

H. Tan, R. Shapiro, A. Tevar, J. Donaldson, A. Basu, M. Sturdevant, R. Lopez, M. Wijkstrom, J. McCauley, C. Wu, N. Shah, A. Humar

Surgery, Starzl Transplant Institute, University of Pittsburgh Medical Center, Pittsburgh, PA

Meeting: 2013 American Transplant Congress

Abstract number: B1095

Topic:

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.

To cite this abstract in AMA style:

Tan H, Shapiro R, Tevar A, Donaldson J, Basu A, Sturdevant M, Lopez R, Wijkstrom M, McCauley J, Wu C, Shah N, Humar A. 1025 Deceased Donor Kidney Transplants Using Alemtuzumab Pretreatment and Tacrolimus Monotherapy: 10 Year Experience [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/1025-deceased-donor-kidney-transplants-using-alemtuzumab-pretreatment-and-tacrolimus-monotherapy-10-year-experience/. Accessed May 9, 2021.

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