Campath-1H induction therapy in African American and Hispanic first renal transplant recipients: 3-year actuarial follow-up.
BACKGROUND
In a retrospective study of the first 75 primary renal transplant patients given alemtuzumab induction at our center, 20 were African American (27%), 32 were Hispanic (43%), and 23 were non-African American, non-Hispanic (31%).


METHODS
Alemtuzumab was given intraoperatively and 4 days later (0.3 mg/kg), with planned low-dose maintenance mycophenolate mofetil (500 mg twice daily) and tacrolimus (targeted trough levels of 5 to 7 ng/ml) and no corticosteroid therapy after the first week. Median follow-up among ongoing survivors with a functioning graft was 45 months.


RESULTS
Three-year actuarial patient and graft survival rates were 95% and 85% in African Americans, 89% and 78% in Hispanics, and 96% and 96% in non-African Americans, non-Hispanics, respectively (not significant). Bioavailability of tacrolimus was significantly lower among African Americans in comparison with the other patient subgroups (P<or=.002). While the incidence of biopsy-proven acute rejection was 20% (4/20) in African Americans, 19% (6/32) in Hispanics, and 13% (3/23) in non-African American, non-Hispanic (not significant), chronic allograft dysfunction occurred more frequently among African Americans (10/20) in comparison with Hispanics (8/32) and non-African American, non-Hispanics (8/23) (P=0.08, log-rank test). In addition, there was a trend at 6 and 12 months posttransplant for the mean serum creatinine to be less favorable among African American patients (P=0.08 and 0.07). No group had increased infection or malignancy.


CONCLUSIONS
This immunosuppressive protocol appears reasonably safe for 3 years after renal transplantation but suggests higher incidences of biopsy-proven acute rejection, chronic allograft dysfunction, and borderline poorer renal function among African Americans in comparison with the other patient subgroups.
Ciancio
Gaetano
G
Lillian Jean Kaplan Renal Transplant Center, Division of Transplantation, Department of Surgery, University of Miami Miller School of Medicine, Miami, FL 33101, USA. gciancio@med.miami.edu
Burke
George W
GW
Gaynor
Jeffrey J
JJ
Sageshima
Junichiro
J
Herrada
Eva
E
Tueros
Lissett
L
Roth
David
D
Kupin
Warren
W
Rosen
Anne
A
Esquenazi
Violet
V
Miller
Joshua
J
D000328:Adult; D000074323:Alemtuzumab; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000627:therapeutic use; D044383:Black People; D002423:Cause of Death; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000188:drug therapy / Q000453:epidemiology; D006085:Graft Survival; D006630:Hispanic or Latino; D006650:Histocompatibility Testing; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000009:adverse effects / Q000276:immunology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009926:Organ Preservation; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D016019:Survival Analysis; D014019:Tissue Donors / Q000706:statistics & numerical data; D001741:Black or African American
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm; D000970:Antineoplastic Agents; D007166:Immunosuppressive Agents; D000074323:Alemtuzumab