Alemtuzumab versus interleukin-2 receptor antibodies induction in living donor kidney transplantation.
BACKGROUND
Alemtuzumab use has been increasing in kidney transplantation. We aimed to compare posttransplantation outcomes between alemtuzumab and interleukin-2 receptor antibodies (IL-2RA) in living donor kidney transplant recipients in the United States.


METHODS
Organ Procurement Transplant Network/United Network of Organ Sharing data, as of August 2007, were used to identify all living donor kidney transplants performed in adults in the United States from 2003 to 2006 where induction therapy with alemtuzumab or IL-2RA (daclizumab or basiliximab) was used. Primary outcomes included incidence of acute rejection, graft survival, and patient survival.


RESULTS
One thousand nine hundred thirteen recipients received alemtuzumab and 7011 received IL-2RA. There were few significant differences in baseline characteristics. The incidence of acute rejection at discharge was lower in the alemtuzumab group, when compared with that in the IL-2RA group (0.8% vs. 4.4%, respectively, P<0.001), but it was similar by 1 year posttransplant (9.8% vs. 11%, respectively). After adjusting for confounding factors, those in alemtuzumab group had a higher adjusted relative risk of graft loss (hazard ratios 1.23, 95% CI 1.03-1.48) in 4 years. Patient survival was comparable between the study groups. A higher rate of acute rejection and graft failure was seen in the recipients who used triple regimen (calcineurin-mycophenolate-steroid) in association with alemtuzumab.


CONCLUSIONS
The incidence of acute rejection at discharge was lower with alemtuzumab but was comparable with IL-2RA up to 1 year posttransplant. There was no difference in patient survival, but the risk of graft loss among patients who received alemtuzumab was higher compared with those who received IL-2RA induction.
Sampaio
Marcelo S
MS
Division of Nephrology, Kidney and Pancreas Transplant Program, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
Kadiyala
Aditya
A
Gill
Jagbir
J
Bunnapradist
Suphamai
S
D000328:Adult; D000368:Aged; D000074323:Alemtuzumab; D000906:Antibodies / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm / Q000627:therapeutic use*; D001706:Biopsy; D004359:Drug Therapy, Combination; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015994:Incidence; D016030:Kidney Transplantation / Q000276:immunology* / Q000401:mortality; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D015375:Receptors, Interleukin-2 / Q000276:immunology*; D012044:Regression Analysis; D015996:Survival Rate; D017741:Survivors; D014481:United States
D000906:Antibodies; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm; D007166:Immunosuppressive Agents; D015375:Receptors, Interleukin-2; D000074323:Alemtuzumab