Alemtuzumab and liver transplantation: a review.
OBJECTIVE
Liver transplantation has always been fraught with conflict. The ongoing shortage of organs for transplantation has led to sicker recipients and the pressure to utilize more marginal grafts. At the same time, increasing public scrutiny and regulatory oversight have emphasized lower costs and better outcomes. This environment exaggerates the importance of the most fundamental conflict: that between preventing allograft rejection and avoiding the toxicities of immunosuppressive agents and the risks of infection. Resolving this struggle requires skillful balancing and a need to keep abreast of the latest developments. Alemtuzumab is a still-new agent with relatively little clinical experience that, therefore, deserves a review and an update of current knowledge in the setting of liver transplantation.


RESULTS
The use of alemtuzumab in liver transplant recipients has shown promise with little information to support concerns over significantly increased risks of infectious complications. However, there have been very few studies overall and fewer still in the last 2-3 years. Much of what is known must still be extrapolated from experience in kidney transplant recipients.


CONCLUSIONS
Alemtuzumab appears to be a drug with significant potential advantages for liver transplant recipients. Improved renal function may be the largest potential advantage. However, the advantages may be offset in some groups. Defining subgroups will be critical to the definition of the optimal role of alemtuzumab in liver transplant recipients.
University of Southern California, Los Angeles, California, USA.
Shawn
S
Dhesi
Brendon
B
Boland
Steven
S
Colquhoun
D000074323:Alemtuzumab; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control*; D006085:Graft Survival / Q000187:drug effects*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D007674:Kidney Diseases / Q000209:etiology / Q000517:prevention & control; D016031:Liver Transplantation / Q000009:adverse effects*; D018579:Patient Selection; D018570:Risk Assessment; D016896:Treatment Outcome
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm; D007166:Immunosuppressive Agents; D000074323:Alemtuzumab