title: Kidney after nonrenal transplantation-the impact of alemtuzumab induction.
abstract: BACKGROUND
  Calcineurin inhibitor nephrotoxicity in nonrenal allograft recipients can lead to end-stage renal disease and the need for kidney transplantation. We sought to evaluate the role of alemtuzumab induction in this population.
  
  
  METHODS
  We evaluated 144 patients undergoing kidney transplantation after nonrenal transplantation between May 18, 1998, and October 8, 2007. Seventy-two patients transplanted between January 15, 2003, and October 8, 2007, received alemtuzumab induction and continued their pretransplant immunosuppression. Seventy-two patients transplanted between May 18, 1998, and July 21, 2007, did not receive alemtuzumab induction, but received additional steroids and maintenance immunosuppression. Donor and recipient demographics were comparable.
  
  
  RESULTS
  Overall, 1- and 3-year patient survival and renal function were comparable between the two groups. One- and 3-year graft survival was 93.0% and 75.3% in the alemtuzumab group and 83.3% and 68.7% in the no alemtuzumab group, respectively (P=0.051). The incidence of acute rejection was lower in the alemtuzumab group, 15.3%, than in the no alemtuzumab group, 41.7% (P=0.0001). The incidence of delayed graft function was lower in the alemtuzumab group, 9.7%, than in the no alemtuzumab group, 25.0% (P=0.003). The incidence of viral complications was comparable.
  
  
  CONCLUSIONS
  Alemtuzumab induction with simple resumption of baseline immunosuppression in patients undergoing kidney transplantation after nonrenal transplantation represents a reasonable immunosuppressive strategy.
authors.affiliation: Department of Surgery, Division of Transplantation, Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, PA 15213, USA. shapiror@upmc.edu
authors.forename: Ron
authors.initials: R
authors.lastname: Shapiro
authors.forename: Amit
authors.initials: A
authors.lastname: Basu
authors.forename: Henkie P
authors.initials: HP
authors.lastname: Tan
authors.forename: Claire
authors.initials: C
authors.lastname: Morgan
authors.forename: Vivek
authors.initials: V
authors.lastname: Sharma
authors.forename: Deanna
authors.initials: D
authors.lastname: Blisard
authors.forename: Parmjeet S
authors.initials: PS
authors.lastname: Randhawa
authors.forename: Igor
authors.initials: I
authors.lastname: Dvorchik
authors.forename: Jerry
authors.initials: J
authors.lastname: McCauley
authors.forename: Demetrius
authors.initials: D
authors.lastname: Ellis
authors.forename: J Wallis
authors.initials: JW
authors.lastname: Marsh
authors.forename: Steven
authors.initials: S
authors.lastname: Webber
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Kurland
authors.forename: Kenneth R
authors.initials: KR
authors.lastname: McCurry
authors.forename: Kareem
authors.initials: K
authors.lastname: Abu-Elmagd
authors.forename: George
authors.initials: G
authors.lastname: Mazariegos
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Starzl
mesh_terms: D000328:Adult; D000368:Aged; D000074323:Alemtuzumab; D000911:Antibodies, Monoclonal / Q000009:adverse effects*; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm / Q000009:adverse effects*; D065095:Calcineurin Inhibitors; D002648:Child; D005260:Female; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D007668:Kidney / Q000187:drug effects*; D007676:Kidney Failure, Chronic / Q000209:etiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D019172:Transplantation Conditioning / Q000009:adverse effects; D019737:Transplants; D055815:Young Adult
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm; D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D000074323:Alemtuzumab