Preliminary experience with campath 1H (C1H) in intestinal and liver transplantation.
BACKGROUND
The aim of this research was to study the efficacy of campath 1H in combination with low-dose tacrolimus immunosuppression for intestinal, multivisceral, and liver transplantation.


METHODS
Campath 1H (0.3 mg/kg) was administered in four doses: Preoperatively, at the completion of the transplant, and on postoperative days 3 and 7. Tacrolimus levels were maintained between 5 to 10 ng/dL. Suspected or mild rejections were treated with steroids. Moderate or severe rejections were treated with OKT3.


METHODS
We studied three groups of patients: adult recipients of intestinal or multivisceral transplants, high-risk pediatric recipients of small-bowel or multivisceral grafts, and adult liver-transplant recipients.


RESULTS
Twenty-one adult intestinal recipients received 24 grafts. With follow-up of 2.4 to 16 months, 14 patients are alive and 14 grafts are functioning. Eleven high-risk pediatric intestinal recipients received 12 grafts. There were four mortalities in this group, and after a follow up of 1 to 8.5 months, four patients have not experienced a rejection episode. Five adult liver recipients received five grafts. With a follow-up of 3 to 6.2 months, all five patients are alive. There were no rejection episodes in this group, and none of them required steroid therapy.


CONCLUSIONS
This immunosuppressive regimen allows for the avoidance of maintenance adjuvant-steroid treatment in the majority of our patients. Our preliminary data show a trend toward a reduction of the incidence and the severity of rejection episodes, although we need to follow-up larger numbers of patients to confirm these results.
Tzakis
Andreas G
AG
Department of Surgery, Division of Transplantation, University of Miami School of Medicine, Miami, FL 33136, USA.
Kato
Tomoaki
T
Nishida
Seigo
S
Levi
David M
DM
Madariaga
Juan R
JR
Nery
Jose R
JR
Mittal
Naveen
N
Regev
Arie
A
Cantwell
Patricia
P
Gyamfi
Anthony
A
Weppler
Debbie
D
Miller
Joshua
J
Tryphonopoulos
Panagiotis
P
Ruiz
Phillip
P
D000328:Adult; D000074323:Alemtuzumab; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm / Q000009:adverse effects / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D006084:Graft Rejection; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007422:Intestines / Q000637:transplantation*; D016031:Liver Transplantation / Q000401:mortality; D018655:Lymphocyte Count; D016559:Tacrolimus / Q000627:therapeutic use; D014781:Viscera / Q000637:transplantation
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm; D007166:Immunosuppressive Agents; D000074323:Alemtuzumab; D016559:Tacrolimus