Alemtuzumab (Campath-1H) combined with tacrolimus in intestinal and multivisceral transplantation.
BACKGROUND
We combined alemtuzumab (Campath-1H, Berlex Laboratories, Montville, NJ) and tacrolimus (Tac) immunosuppression for intestinal and multivisceral transplantation.


METHODS
A total of 21 adult patients received 24 grafts: 14 intestinal, nine multivisceral, and one liver-intestinal graft. Alemtuzumab was administered perioperatively in four doses with low-dose Tac (levels 10-15 ng/dL) and no maintenance steroids. Tac was substituted with sirolimus in case of Tac-related complications. Suspected or mild rejections were treated with steroids. Moderate rejections were treated with steroids or OKT3. Severe rejections were treated with OKT3.


RESULTS
Of the 16 patients that were followed up for an average of 9 months, 12 are alive with functioning grafts. Two patients experienced severe rejection, three experienced moderate rejection episodes, and seven experienced mild acute rejection episodes. Four patients never developed acute rejection. Infectious complications included a cytomegalovirus enteritis and four fungal infections (related to central venous access).


CONCLUSIONS
The combination of alemtuzumab and Tac therapy without steroid use seems to efficiently prevent acute rejection in a significant number of patients without causing frequent opportunistic infections.
Tzakis
Andreas G
AG
Department of Surgery, Division of Transplantation, University of Miami School of Medicine, Florida 33136, USA.
Kato
Tomoaki
T
Nishida
Seigo
S
Levi
David M
DM
Tryphonopoulos
Panagiotis
P
Madariaga
Juan R
JR
De Faria
Werviston
W
Nery
Jose R
JR
Regev
Arie
A
Vianna
Rodrigo
R
Miller
Joshua
J
Esquenazi
Violet
V
Weppler
Debbie
D
Ruiz
Phillip
P
D000328:Adult; D000074323:Alemtuzumab; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D006084:Graft Rejection / Q000517:prevention & control; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D007422:Intestines / Q000637:transplantation*; D016031:Liver Transplantation; D011183:Postoperative Complications; D011446:Prospective Studies; D016559:Tacrolimus / Q000008:administration & dosage*
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm; D007166:Immunosuppressive Agents; D000074323:Alemtuzumab; D016559:Tacrolimus