Abstract
Alemtuzumab and rabbit antithymocyte globulin (rATG) are commonly used for induction therapy in renal transplantation. This retrospective, single-center, cohort study evaluated cumulative incidence of 1-year biopsy-proven acute rejection (BPAR) among 200 consecutive primary non-sensitized kidney transplant recipients who received either alemtuzumab (n=100) or rATG (n=100) induction followed by rapid steroid taper, tacrolimus and mycophenolate mofetil (MMF). Protocol biopsies, plasma and urine BK virus PCR, serum creatinine and iothalamate GFR (iGFR) were obtained at 1, 4 and 12 months from transplantation. The 1-year BPAR rates were similar between the alemtuzumab and rATG groups; however, rejection Banff IA and higher was more common in the alemtuzumab arm (18% vs. 5%, P=0.047). After adjusting for confounding variables, alemtuzumab was still associated with Banff IA and higher rejection (adjusted OR: 3.7, CI: 1.2-10.5, P=0.02). Despite similar rates of BK viremia, more patients in the alemtuzumab arm developed BK nephropathy (16% vs. 3%, P=0.046). 1-year iGFR (53.4 ± 20.2 vs. 71.9 ± 27.2 ml/min/1.73 m2, P=0.002) and 3-year graft survival (89.5% vs. 95%, P=0.05) were lower in the alemtuzumab group. In low immunological risk kidney transplant recipients on steroid free immunosuppression, alemtuzumab was associated with more severe rejection and BK nephropathy compared to rATG.
This article is protected by copyright. All rights reserved.
http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2Fctr.12532
Sent with Reeder
Alberto Reino Buelvas
No comments:
Post a Comment