Earlier Repletion of Lymphocytes After Alemtuzumab Induction Is Associated with a Lower Incidence of Infection Following Renal Transplantation.
Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, United Kingdom.
Meeting: 2016 American Transplant Congress
Abstract number: 223
Keywords: Adverse effects, Immunosuppression, Induction therapy, Lymphocytes
Session Information
Date: Monday, June 13, 2016
Session Name: Concurrent Session: Kidney: Induction Therapy 1
Session Time: 2:30pm-4:00pm
Presentation Time: 3:06pm-3:18pm
Location: Room 312
Introduction: Alemtuzumab has been increasingly used as an induction agent in renal transplantation, although the optimal dose is unknown. We have previously reported that alemtuzumab dose adjusted for weight (AD) resulted in a reduction of microbiologically proven infection episodes compared with a historic control group who received a standard dose of 30mg (SD), without an apparent increase in rejection rates.
Methods: In this study we have examined the rate of leucocyte repletion in 366 patients receiving AD (0.4mg/kg) and 590 patients receiving SD alemtuzumab induction. All received tacrolimus monotherapy.
Results: There was no difference in gender, ethnicity, type of graft, regrafts, diabetes and HLA mismatch between the groups. The AD group were older [52.3±12.9 versus 48.9±13.3, p=0.001] and were more likely to be sensitised [139/366(38.0%) versus 129/590(21.9%), p<0.001]. There was no difference in weight at the time of transplant [75.4±17.9 versus 76.1±17.5kg, p=0.58], with the range of doses given in the AD group of 13.6-50mg. On multivariate analysis, factors associated with infection were older age (p=0.0048), diabetes (p=0.002) and female gender (<0.001). Receiving a live donor transplant (p=0.0017) and AD alemtuzumab (p=0.019) were protective against infection. In the AD group there was a significantly earlier time to repletion of lymphocytes and monocytes. The table below shows the mean lymphocyte count in the SD and AD groups during the first year after transplantation.
| Month | Standard Dose | Adjusted Dose | pv alue |
| 1 | 0.3±0.2 | 0.4±0.4 | <0.001 |
| 2 | 0.5±0.3 | 0.6±0.4 | <0.001 |
| 3 | 0.7±0.4 | 0.9±0.5 | <0.001 |
| 6 | 1.0±0.5 | 1.2±0.6 | <0.001 |
| 9 | 1.1±0.5 | 1.3±0.5 | <0.001 |
| 12 | 1.2±0.6 | 1.3±0.5 | 0.0002 |
Discussion: Alemtuzumab dose adjusted for weight at the time of transplantation is associated with a reduction in infection episodes. Repletion of total WCC, lymphocytes and monocytes occurs significantly earlier in the AD group, which may explain the reduction in infective episodes.
CITATION INFORMATION: Willicombe M, Goodall D, McLean A, Taube D. Earlier Repletion of Lymphocytes After Alemtuzumab Induction Is Associated with a Lower Incidence of Infection Following Renal Transplantation. Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:
Willicombe M, Goodall D, McLean A, Taube D. Earlier Repletion of Lymphocytes After Alemtuzumab Induction Is Associated with a Lower Incidence of Infection Following Renal Transplantation. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/earlier-repletion-of-lymphocytes-after-alemtuzumab-induction-is-associated-with-a-lower-incidence-of-infection-following-renal-transplantation/. Accessed March 4, 2021.« Back to 2016 American Transplant Congress