title: Five-year outcomes with alemtuzumab induction after lung transplantation.
abstract: BACKGROUND
  Induction therapy with alemtuzumab, followed by lower than conventional intensity post-transplant immunosuppression (eg, tacrolimus monotherapy), has been associated with reduced morbidity and mortality in abdominal and heart transplantation. We examined 5-year outcomes in lung recipients receiving alemtuzumab in conjunction with reduced-intensity post-transplant immunosuppression (early lower-dose tacrolimus; lower-dose steroids, with or without mycophenolate mofetil), compared with lung recipients receiving other induction agents or no induction in association with post-transplant immunosuppression.
  
  
  METHODS
  A retrospective analysis was performed using prospectively collected data from a single-site clinical database of 336 lung recipients (aged ≥ 18) who received allografts between 1998 and 2005, classified by induction type: alemtuzumab, 127; Thymoglobulin, 43; daclizumab, 73; and none, 93. Survival analyses examined patient and graft survival, and freedom from acute cellular rejection (ACR), lymphocytic bronchiolitis, obliterative bronchiolitis (OB), bronchiolitis obliterans syndrome (BOS), and post-transplant lymphoproliferative disorder (PTLD).
  
  
  RESULTS
  Five-year patient and graft survival differed by group (p = 0.046, p = 0.038, respectively). Alemtuzumab patient/graft survival rates were 59%/59%. Survival rates were 60%/44% for Thymoglobulin, 47%/46% for no induction, and 44%/41% for daclizumab. Freedom from ACR, lymphocytic bronchiolitis, OB, and BOS differed by group (all values, p < 0.008); alemtuzumab recipients showed greater 5-year freedom from each outcome (30%/82%/86%/54%) than Thymoglobulin (20%/54%/62%/27%), daclizumab (19%/55%/70%/43%), and no-induction groups (18%/70%/69%/46%). The groups did not differ in PTLD rates (≥ 94% free of PTLD at 5 years; p = 0.864). Effects were unchanged after controlling for potential covariates.
  
  
  CONCLUSIONS
  Alemtuzumab induction may be associated with improved outcomes in lung transplantation. Randomized controlled trials are needed to establish any effects of this agent.
authors.affiliation: Department of Medicine, University of Pittsburgh School of Medicine and Medical Center, Pittsburgh, Pennsylvania 15213, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Shyu
authors.forename: Mary Amanda
authors.initials: MA
authors.lastname: Dew
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Pilewski
authors.forename: Annette J
authors.initials: AJ
authors.lastname: DeVito Dabbs
authors.forename: Diana B
authors.initials: DB
authors.lastname: Zaldonis
authors.forename: Sean M
authors.initials: SM
authors.lastname: Studer
authors.forename: Maria M
authors.initials: MM
authors.lastname: Crespo
authors.forename: Yoshiya
authors.initials: Y
authors.lastname: Toyoda
authors.forename: Christian A
authors.initials: CA
authors.lastname: Bermudez
authors.forename: Kenneth R
authors.initials: KR
authors.lastname: McCurry
mesh_terms: D000328:Adult; D000074323:Alemtuzumab; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm / Q000627:therapeutic use*; D000961:Antilymphocyte Serum / Q000627:therapeutic use; D001988:Bronchiolitis / Q000209:etiology; D000077561:Daclizumab; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000188:drug therapy* / Q000517:prevention & control; D006085:Graft Survival; D006801:Humans; D007074:Immunoglobulin G / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016040:Lung Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm; D000961:Antilymphocyte Serum; D007074:Immunoglobulin G; D007166:Immunosuppressive Agents; D000074323:Alemtuzumab; D000077561:Daclizumab; C512542:thymoglobulin