title: Dissociation of depletional induction and posttransplant lymphoproliferative disease in kidney recipients treated with alemtuzumab.
abstract: Transplant patients are at the risk for posttransplant lymphoproliferative disease (PTLD), a virally-driven malignancy. Induction with the depleting antibody preparations Thymoglobulin and OKT3 is associated with PTLD suggesting that the T-cell depletion increases PTLD risk. We therefore studied 59 560 kidney recipients from the Organ Procurement and Transplantation Network/United Network for Organ Sharing (OPTN/UNOS) database for a relationship between induction agent use and PTLD. Two agents with comparable T-cell depletional effects, alemtuzumab and Thymoglobulin, were compared to nondepletional induction agents or no induction. The overall incidence of PTLD was 0.46% and differed significantly by induction strategy (p < 0.01): without induction (0.43%), basiliximab (0.38%), daclizumab (0.33%), Thymoglobulin (0.67%) and alemtuzumab (0.37%). Thymoglobulin was associated with significantly increased PTLD risk (p = 0.0025), but alemtuzumab (p = 0.74), basiliximab (p = 0.33) and daclizumab, which trended toward a protective effect (p = 0.06), were not. Alemtuzumab and Thymoglobulin treated patients did not differ in any established parameter affecting PTLD risk although alemtuzumab is known to have a more pronounced B-cell depleting effect. Interestingly, maintenance therapy with an mTOR inhibitor was strongly associated with PTLD (0.71%, p < 0.0001). Thus, depletional induction is not an independent risk factor for PTLD. Rather, maintenance drug selection or perhaps the balance between B- and T-cell depletion may be more relevant determinants of PTLD risk.
authors.affiliation: The Emory Transplant Center, Emory University, Atlanta, GA, USA. allan.kirk@emoryhealthcare.org
authors.forename: A D
authors.initials: AD
authors.lastname: Kirk
authors.forename: W S
authors.initials: WS
authors.lastname: Cherikh
authors.forename: M
authors.initials: M
authors.lastname: Ring
authors.forename: G
authors.initials: G
authors.lastname: Burke
authors.forename: D
authors.initials: D
authors.lastname: Kaufman
authors.forename: S J
authors.initials: SJ
authors.lastname: Knechtle
authors.forename: S
authors.initials: S
authors.lastname: Potdar
authors.forename: R
authors.initials: R
authors.lastname: Shapiro
authors.forename: V R
authors.initials: VR
authors.lastname: Dharnidharka
authors.forename: H M
authors.initials: HM
authors.lastname: Kauffman
mesh_terms: D000293:Adolescent; D000328:Adult; D000074323:Alemtuzumab; D000911:Antibodies, Monoclonal / Q000009:adverse effects*; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm / Q000009:adverse effects*; D002648:Child; D004359:Drug Therapy, Combination; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016030:Kidney Transplantation / Q000276:immunology*; D008212:Lymphocyte Depletion / Q000379:methods*; D008232:Lymphoproliferative Disorders / Q000139:chemically induced / Q000453:epidemiology / Q000276:immunology*; D011183:Postoperative Complications / Q000139:chemically induced / Q000276:immunology*; D013997:Time Factors
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm; D007166:Immunosuppressive Agents; D000074323:Alemtuzumab