title: Campath-1H induction plus rapamycin monotherapy for renal transplantation: results of a pilot study.
abstract: Campath-1H, an anti-CD52 monoclonal antibody, was used as induction therapy (40 mg i.v. total dose) in 29 primary human renal transplants, and the patients were maintained on rapamycin monotherapy (levels 8-15 ng/mL) post-transplant. Campath-1H profoundly depletes lymphocytes long-term and more transiently depletes B cells and monocytes. All patients are alive and well at 3-29 months of follow up. One graft was lost because of rejection. There have been no systemic infections and no malignancies. Eight of 29 patients have experienced rejection, which was successfully treated in seven of eight patients. Five of these patients had pathological evidence of a humoral component of their rejection. Seven of the 29 patients were converted to standard triple therapy on account of rejection. Rapamycin was generally well tolerated in that there were no significant wound-healing problems; two lymphoceles required surgical drainage; and most patients were treated with a lipid-lowering agent. Flow crossmatch testing post-transplant revealed evidence of alloantibody in two patients tested with previous combined cellular and humoral rejection. Biopsies have shown no chronic allograft nephropathy to date. In view of the relatively high incidence of early humoral rejection, we plan to modify the immunosuppressive regimen in subsequent pilot studies. This clinical trial provides insight into the use of Campath-1H induction in combination with rapamycin maintenance monotherapy.
authors.affiliation: Department of Surgery, University of Wisconsin Medical School, Madison, WI, USA. stuart@tx.surgery.wisc.edu
authors.forename: Stuart J
authors.initials: SJ
authors.lastname: Knechtle
authors.forename: John D
authors.initials: JD
authors.lastname: Pirsch
authors.forename: John
authors.initials: J
authors.lastname: H  Fechner
authors.forename: Bryan N
authors.initials: BN
authors.lastname: Becker
authors.forename: Andreas
authors.initials: A
authors.lastname: Friedl
authors.forename: Robert B
authors.initials: RB
authors.lastname: Colvin
authors.forename: Lauralynn K
authors.initials: LK
authors.lastname: Lebeck
authors.forename: L Thomas
authors.initials: LT
authors.lastname: Chin
authors.forename: Yolanda T
authors.initials: YT
authors.lastname: Becker
authors.forename: Jon S
authors.initials: JS
authors.lastname: Odorico
authors.forename: Anthony M
authors.initials: AM
authors.lastname: D'Alessandro
authors.forename: Munci
authors.initials: M
authors.lastname: Kalayoglu
authors.forename: Majed M
authors.initials: MM
authors.lastname: Hamawy
authors.forename: Huaizhong
authors.initials: H
authors.lastname: Hu
authors.forename: Debra D
authors.initials: DD
authors.lastname: Bloom
authors.forename: Hans W
authors.initials: HW
authors.lastname: Sollinger
mesh_terms: D000293:Adolescent; D000328:Adult; D000074323:Alemtuzumab; D000906:Antibodies / Q000276:immunology; D000911:Antibodies, Monoclonal / Q000494:pharmacology*; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm / Q000494:pharmacology*; D005260:Female; D006084:Graft Rejection / Q000188:drug therapy / Q000276:immunology / Q000517:prevention & control*; D006801:Humans; D007166:Immunosuppressive Agents / Q000494:pharmacology*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D020123:Sirolimus / Q000494:pharmacology*
chemical_list: D000906:Antibodies; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm; D007166:Immunosuppressive Agents; D000074323:Alemtuzumab; D020123:Sirolimus