title: Single dose of alemtuzumab induction with steroid-free maintenance immunosuppression in pancreas transplantation.
abstract: BACKGROUND
  The use of alemtuzumab (humanized anti-CD52 monoclonal antibody) has been primarily studied in renal transplantation, and the experience of alemtuzumab induction in pancreas transplantation is still limited. The objective of this study is to analyze the outcome of pancreas transplantation by using a single dose of 30 mg alemtuzumab induction with steroid-free maintenance immunosuppression.
  
  
  METHODS
  We performed a total 28 pancreas transplants (17 simultaneous kidney-pancreas transplantation [SPK], 5 pancreas after kidney transplantation [PAK], and 6 pancreas transplant alone [PTA]) between November 2006 and April 2010. Median follow-up was 25 months (range, 8-49 months). Maintenance immunosuppression consists of tacrolimus and mycophenolate. We analyzed patient/graft survival, graft function, and complications.
  
  
  RESULTS
  One-year actuarial patient/graft survival was 100%/100% in SPK, PAK, and PTA. Three-year actuarial patient/pancreas graft survival rates for SPK, PAK, and PTA were 100%/100%, 100%/100%, and 100%/83%, respectively. Excellent pancreas and kidney graft functions were observed. Acute cellular rejection occurred in 42% of patients. Most of the rejection episode occurred approximately 1 or 6 months after transplant. Absolute lymphocyte count remained below preoperative level for 1 year posttransplant and WBC counts were significantly lower for 3 years after transplant compared with pretransplant level. Cytomegalovirus infection and bacterial infection occurred in 28% and 36% of patients, respectively. Eleven percent of patients developed donor-specific antibodies and 7% of patients experienced antibody-mediated rejection.
  
  
  CONCLUSIONS
  A single dose of 30 mg alemtuzumab induction with steroid-free maintenance immunosuppression achieved excellent mid-term patient and graft survival for pancreas transplantation with acceptable complication rate.
authors.affiliation: Division of Transplantation, Department of Surgery, The Pennsylvania State University, College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA 17033, USA. tuemura@hmc.psu.edu
authors.forename: Tadahiro
authors.initials: T
authors.lastname: Uemura
authors.forename: Varun
authors.initials: V
authors.lastname: Ramprasad
authors.forename: Kazuhide
authors.initials: K
authors.lastname: Matsushima
authors.forename: Hiroko
authors.initials: H
authors.lastname: Shike
authors.forename: Tracy
authors.initials: T
authors.lastname: Valania
authors.forename: Osun
authors.initials: O
authors.lastname: Kwon
authors.forename: Nasrollah
authors.initials: N
authors.lastname: Ghahramani
authors.forename: Riaz
authors.initials: R
authors.lastname: Shah
authors.forename: Umar
authors.initials: U
authors.lastname: Farooq
authors.forename: Akhtar
authors.initials: A
authors.lastname: Khan
authors.forename: Zakiyah
authors.initials: Z
authors.lastname: Kadry
mesh_terms: D000293:Adolescent; D000328:Adult; D000074323:Alemtuzumab; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D000912:Antibodies, Neoplasm / Q000627:therapeutic use*; D002648:Child; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007165:Immunosuppression Therapy; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D016035:Pancreas Transplantation / Q000276:immunology* / Q000379:methods*; D013256:Steroids; D016559:Tacrolimus / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm; D007166:Immunosuppressive Agents; D013256:Steroids; D000074323:Alemtuzumab; D009173:Mycophenolic Acid; D016559:Tacrolimus