699 Living 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: C1343

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

We performed 699 consecutive unselected LDKT from 12/11/2002 to 8/23/2012 using 30 mg or 0.5mg/kg alemtuzumab pretreatment and tacrolimus monotherapy. Tacrolimus was weaned 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 7 (1.0%) HIV+, 74 (10.6%) pediatric recipients, 65 (9.3%) African American, 41 (5.9%) patients >70 yrs old, 32 (4.6%) patients with PRA>20%, and 103 (14.7%) re-transplants. The mean follow up was 61.0±30.5 months.

Mean recipient age for adult and pediatric recipients was 47.4±15.0 and 8.9±5.8 years respectively. Actuarial recipient survivals at 1-, 2-, 3-, 4-, 5-, 6-, 7-, 8-, and 9-years were 98.2%, 96.1%, 94.3%, 92.4%, 89.0%, 84.2%, 81.0%, 75.0%, and 71.6%, respectively. Graft survivals at 1-, 2-, 3-, 4-, 5-, 6-, 7-, 8-, and 9-years were 97.2%, 91.7%, 88.0%, 82.5%, 77.3%, 69.3%, 63.9%, 57.4%, and 49.3% respectively. The mean GFR (mL/min/1.73m²) at 1-, 2-, 3-, 4-, 5-, 6-, 7-, 8-, and 9- years were 60±25, 56±23, 56±23, 55±22, 53±22, 53±22, 53±23, 52±26, and 47±21, 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 5.3%, 9.6%, 16.7%, 21.3%, 24.9%, 26.3%, 27.6%, 28.6%, 29.0%, 29.3%, and 29.3% respectively. Most ACR were Banff 1 and sensitive to steroid pulse. There were 16.0% (112) 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 2 (0.3%) cases of CMV disease, 14.2% underwent CMV seroconversion; 34.3% had BK viuria, 10.2% had BK viremia, 6.3% with BKVN.

The 10 year experience of Alemtuzumab (Campath-1H) pretreatment with tacrolimus monotherapy for LDKT 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. 699 Living Donor Kidney Transplants Using Alemtuzumab Pretreatment and Tacrolimus Monotherapy: 10 Year Experience [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/699-living-donor-kidney-transplants-using-alemtuzumab-pretreatment-and-tacrolimus-monotherapy-10-year-experience/. Accessed June 17, 2025.

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