title: Alemtuzumab induction prior to cardiac transplantation with lower intensity maintenance immunosuppression: one-year outcomes.
abstract: Induction therapy with alemtuzumab (C-1H) prior to cardiac transplantation (CTX) may allow for lower intensity maintenance immunosuppression. This is a retrospective study of patients who underwent CTX at a single institution from January 2001 until April 2009 and received no induction versus induction with C-1H on a background of tacrolimus and mycophenolate. Those with C-1H received dose-reduced calcineurin inhibitor and no steroids. A total of 220 patients were included, 110 received C-1H and 110 received no induction. Recipient baseline characteristics, donor age and gender were not different between the two groups. Mean tacrolimus levels (ng/mL) for C-1H versus no induction: months 1-3 (8.5 vs. 12.9), month 4-6 (10.2 vs. 13.0), month 7-9 (10.2 vs. 11.9) and month 10-12 (9.9 vs. 11.3) were all significantly lower for the C-1H group, p < 0.001. There were no differences between the C-1H and no induction groups at 12 months for overall survival 85.1% versus 93.6% p = 0.09, but freedom from significant rejection was significantly higher for the C-1H group, 84.5% versus 51.6%, p < 0.0001. In conclusion, induction therapy after CTX with C-1H results in a similar 12 month survival, but a greater freedom from rejection despite lower calcineurin levels and without the use of steroids.
authors.affiliation: Cardiovascular Institute, University of Pittsburgh, 200 Lothrop Street, Pittsburgh, PA, USA. teutebergjj@upmc.edu
authors.forename: J J
authors.initials: JJ
authors.lastname: Teuteberg
authors.forename: M A
authors.initials: MA
authors.lastname: Shullo
authors.forename: R
authors.initials: R
authors.lastname: Zomak
authors.forename: Y
authors.initials: Y
authors.lastname: Toyoda
authors.forename: D M
authors.initials: DM
authors.lastname: McNamara
authors.forename: C
authors.initials: C
authors.lastname: Bermudez
authors.forename: R L
authors.initials: RL
authors.lastname: Kormos
authors.forename: K R
authors.initials: KR
authors.lastname: McCurry
mesh_terms: D000074323:Alemtuzumab; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm; D019703:Calcineurin / Q000276:immunology; D003520:Cyclophosphamide / Q000276:immunology; D016027:Heart Transplantation / Q000276:immunology; D006801:Humans; D007165:Immunosuppression Therapy; D007166:Immunosuppressive Agents / Q000276:immunology; D012189:Retrospective Studies; D013256:Steroids / Q000276:immunology; D016559:Tacrolimus / Q000276:immunology; D014019:Tissue Donors; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm; D007166:Immunosuppressive Agents; D013256:Steroids; D000074323:Alemtuzumab; D003520:Cyclophosphamide; D019703:Calcineurin; D016559:Tacrolimus