Introduction: Highly-HLA sensitized transplant recipients (HS) are at increased risk for AR/AMR after transplant. Subcutaneous alemtuzumab, a humanized anti-CD52 monoclonal antibody, appears both safe and effective for use as an induction agent for renal allograft recipients. Here, we report our 5-year results from a single center experience using alemtuzumab as induction for HS renal transplant recipients.

Methods: From October 2005 to November 2011, 199 HS patients were desensitized with IVIG + rituximab, IVIG alone or IVIG + rituximab and PLEX. At transplant, all received 30 mg of subcutaneous alemtuzumab as induction therapy (G1). Results were compared to a cohort of 149 non-sensitized, low risk patients transplanted concurrently (G2). Patient and graft survival, serum creatinines, rejection episodes, adverse events and infectious complications were monitored.

Results: Over 55% of HS patients were followed for more than 3 years. Patient survival was 99%, 97%, 97%, 95%, and 94% at 1-, 2-, 3-,4-and 5-year respectively. Graft survival was 96%, 93%, 88%, 85%, and 82% at each follow-up years. Mean serum creatinine at 12-, 24-, 36-, 48- and 60 months were 1.2±0.7mg/dL, 1.3±1.1mg/dL, 1.3±0.5mg/dL, 1.5±0.5mg/dL and 1.5±0.9mg/dL respectively. Acute rejection episodes occurred in 33% of patients, with anti-body mediated rejection for 68% of these episodes. Graft loss occurred in 13% of all transplants and immunological rejection being the etiology in 48% of graft loss. Post-transplant viral infections (CMV/BK viremia or BK nephropathy) were seen in 26% of patients. There were significantly more ABMR episodes and graft losses in the alemtuzumab group compared to non-sensitized patients receiving induction with low-risk group. More deaths were seen in the low-risk group.

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