title: Alemtuzumab induction and tacrolimus monotherapy in pancreas transplantation: One- and two-year outcomes.
abstract: BACKGROUND
  Alemtuzumab (Campath-1H) induction with tacrolimus monotherapy has been shown to provide effective immunosuppression for kidney, liver, lung, and small bowel transplantation. This drug combination was evaluated in pancreas transplant recipients.
  
  
  METHODS
  Sixty consecutive pancreas transplants (30 simultaneous pancreas-kidney, 20 pancreas after kidney, and 10 pancreas alone) were carried out under this protocol between July 2003 to January 2005. The mean follow-up was 22 months (range 17-33).
  
  
  RESULTS
  One-year patient, pancreas, and kidney allograft survival were 95%, 93%, and 90%, respectively. With 22 months follow-up, patient, pancreas, and kidney survival were 94%, 89%, and 87%, respectively. The rejection rate was 30% (18/60), with four patients (7%) experiencing steroid-resistant rejection. Major infection occurred in three (5%) patients resulting in two (3.3%) deaths from disseminated histoplasmosis and a herpes virus infection. One patient with cryptococcal meningitis was successfully treated. Seven (11.7%) patients experienced cytomegalovirus infection, all of whom responded to treatment with ganciclovir. One (1.7%) case of polymorphic posttransplant lymphoproliferative disease was seen, which regressed with a temporary discontinuation of tacrolimus and high-dose ganciclovir. The mean serum creatinine of the 30 simultaneous pancreas-kidney transplants at one year posttransplant was 1.37+/-0.33 mg/ml. The preexisting creatinine in pancreas after kidney transplants was not adversely affected by this immunosuppressive protocol.
  
  
  CONCLUSIONS
  A single dose of perioperative alemtuzumab followed by daily tacrolimus monotherapy provides effective immunosuppression for pancreas transplantation, but the optimal use of this drug combination is not yet clear.
authors.affiliation: Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, PA 15213, USA. thainl@upmc.edu
authors.forename: Ngoc L
authors.initials: NL
authors.lastname: Thai
authors.forename: Akhtar
authors.initials: A
authors.lastname: Khan
authors.forename: Kusum
authors.initials: K
authors.lastname: Tom
authors.forename: Deanna
authors.initials: D
authors.lastname: Blisard
authors.forename: Amit
authors.initials: A
authors.lastname: Basu
authors.forename: Henkie P
authors.initials: HP
authors.lastname: Tan
authors.forename: Amadeo
authors.initials: A
authors.lastname: Marcos
authors.forename: John J
authors.initials: JJ
authors.lastname: Fung
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Starzl
authors.forename: Ron
authors.initials: R
authors.lastname: Shapiro
mesh_terms: D000074323:Alemtuzumab; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D006084:Graft Rejection / Q000150:complications / Q000401:mortality / Q000517:prevention & control*; D006085:Graft Survival; D006801:Humans; D007165:Immunosuppression Therapy; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016035:Pancreas Transplantation / Q000401:mortality; D016559:Tacrolimus / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm; D007166:Immunosuppressive Agents; D000074323:Alemtuzumab; D016559:Tacrolimus