title: Alemtuzumab (Campath-1H) combined with tacrolimus in intestinal and multivisceral transplantation.
abstract: 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.
authors.affiliation: Department of Surgery, Division of Transplantation, University of Miami School of Medicine, Florida 33136, USA.
authors.forename: Andreas G
authors.initials: AG
authors.lastname: Tzakis
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Kato
authors.forename: Seigo
authors.initials: S
authors.lastname: Nishida
authors.forename: David M
authors.initials: DM
authors.lastname: Levi
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Tryphonopoulos
authors.forename: Juan R
authors.initials: JR
authors.lastname: Madariaga
authors.forename: Werviston
authors.initials: W
authors.lastname: De Faria
authors.forename: Jose R
authors.initials: JR
authors.lastname: Nery
authors.forename: Arie
authors.initials: A
authors.lastname: Regev
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Vianna
authors.forename: Joshua
authors.initials: J
authors.lastname: Miller
authors.forename: Violet
authors.initials: V
authors.lastname: Esquenazi
authors.forename: Debbie
authors.initials: D
authors.lastname: Weppler
authors.forename: Phillip
authors.initials: P
authors.lastname: Ruiz
mesh_terms: 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*
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm; D007166:Immunosuppressive Agents; D000074323:Alemtuzumab; D016559:Tacrolimus