title: Outcomes at 3 years of a prospective pilot study of Campath-1H and sirolimus immunosuppression for renal transplantation.
abstract: Campath-1H (alemtuzumab) induction was used for renal transplantation in combination with sirolimus as immunosuppression. We previously reported a high (28%) rate of early rejection with this regimen, and now report 3-year outcomes. Twenty-nine patients were recipients of either deceased donor or non-HLA (Human Leukocyte Antigen) identical living donor primary renal allografts. Clinical parameters including infection, malignancy, kidney function, and kidney histology were followed prospectively for 3 years. Three-year cumulative graft and patient survival were 96% and 100%, respectively. Twenty patients were maintained on steroid-free immunosuppressive regimens, and 15 patients were maintained on monotherapy for immunosuppression (12 on sirolimus). No serious infectious complications were observed and two patients developed basal cell skin cancer. The 3-year results of our initial pilot study demonstrate good graft (96%) and patient (100%) outcomes. Campath-1H induction has yielded a high proportion of patients maintained on immunosuppressive monotherapy (57%) without serious infectious- and no malignancy-related complications. The reported regimen yielded novel insights into both Campath-1H and sirolimus therapy in renal transplantation. Because of the higher incidence of early rejection, we recommend a modified strategy of immunosuppression including a brief course of a calcineurin inhibitor.
authors.affiliation: Department of Surgery, Division of Transplantation, University of Wisconsin School of Medicine and Public Health, Madison, 53792-7375, USA.
authors.forename: Rolf N
authors.initials: RN
authors.lastname: Barth
authors.forename: Christina A
authors.initials: CA
authors.lastname: Janus
authors.forename: Christine A
authors.initials: CA
authors.lastname: Lillesand
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Radke
authors.forename: John D
authors.initials: JD
authors.lastname: Pirsch
authors.forename: Bryan N
authors.initials: BN
authors.lastname: Becker
authors.forename: Luis A
authors.initials: LA
authors.lastname: Fernandez
authors.forename: L
authors.initials: L
authors.lastname: Thomas 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: Hans W
authors.initials: HW
authors.lastname: Sollinger
authors.forename: Stuart J
authors.initials: SJ
authors.lastname: Knechtle
mesh_terms: D000328:Adult; D000074323:Alemtuzumab; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm / Q000627:therapeutic use*; D001706:Biopsy; D065095:Calcineurin Inhibitors; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000494:pharmacology / Q000627:therapeutic use*; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D020123:Sirolimus / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm; D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D000074323:Alemtuzumab; D020123:Sirolimus