Anti-CD25 monoclonal antibody coverage allows for calcineurin inhibitor "holiday" in solid organ transplant patients with acute renal dysfunction.
BACKGROUND
Solid organ transplant (Tx) patients on calcineurin inhibitors (CNI) can develop acute renal dysfunction (ARD), which could be improved by reducing or withholding ("holiday") CNI dose.


METHODS
We used anti-CD25 monoclonal antibodies to prevent acute rejection in 11 adult Tx patients (7 heart, 2 liver, 2 heart-renal Tx), requiring a CNI "holiday" because of 15 events of ARD after the initial postTx hospitalization. An event of ARD was defined as an increase in serum creatinine (Scr)>25% vs. baseline. The CNI "holiday" was implemented until Scr had decreased to baseline. Basiliximab was used in 7 patients (11 events), and daclizumab was used in 4 patients (4 events).


RESULTS
The CNI "holiday" was implemented over 21+/-51 days. Anti-CD25 mAb were well tolerated with no episodes of acute rejection. Scr (micromol/liter) increased from 145+/-48 to 301+/-92 (P<0.0001), and decreased to 143+/-55 with the CNI "holiday."


CONCLUSIONS
Our results suggest that a CNI "holiday" may improve ARD after solid organ Tx without rejection under anti-CD25 mAb coverage.
Cantarovich
Marcelo
M
Department of Medicine, Division of Transplantation, Royal Victoria Hospital, McGill University Health Center, Montreal, Quebec, H3A 1A1, Canada.
Metrakos
Peter
P
Giannetti
Nadia
N
Cecere
Renzo
R
Barkun
Jeffrey
J
Tchervenkov
Jean
J
D000208:Acute Disease; D000368:Aged; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D000077552:Basiliximab; D065095:Calcineurin Inhibitors; D003404:Creatinine / Q000097:blood; D000077561:Daclizumab; D006801:Humans; D007074:Immunoglobulin G / Q000627:therapeutic use*; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation / Q000009:adverse effects*; D015375:Receptors, Interleukin-2 / Q000276:immunology*; D011993:Recombinant Fusion Proteins
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D065095:Calcineurin Inhibitors; D007074:Immunoglobulin G; D007166:Immunosuppressive Agents; D015375:Receptors, Interleukin-2; D011993:Recombinant Fusion Proteins; D000077552:Basiliximab; D003404:Creatinine; D000077561:Daclizumab