title: Treatment of steroid-resistant acute renal allograft rejection with alemtuzumab.
abstract: Steroid-resistant renal allograft rejections are commonly treated with rabbit antithymocyte globulin (RATG), but alemtuzumab could be an effective, safe and more convenient alternative. Adult patients with steroid-resistant renal allograft rejection treated with alemtuzumab (15-30 mg s.c. on 2 subsequent days) from 2008 to 2012 (n = 11) were compared to patients treated with RATG (2.5-4.0 mg/kg bodyweight i.v. for 10-14 days; n = 20). We assessed treatment-failure (graft loss, lack of improvement of graft function or need for additional anti-rejection treatment), infections during the first 3 months after treatment and infusion-related side effects. In both groups, the median time-interval between rejection and transplantation was 2 weeks, and approximately 75% of rejections were classified as Banff-IIA or higher. Three alemtuzumab-treated patients (27%) experienced treatment failure, compared to eight RATG treated patients (40%, p = 0.70). There was no difference in the incidence of infections. There were mild infusion-related side-effects in three alemtuzumab-treated patients (27%), and more severe infusion-related side effects in 17 RATG-treated patients (85%, p = 0.013). Drug related costs of alemtuzumab-treatment were lower than of RATG-treatment (€1050 vs. €2024; p < 0.01). Alemtuzumab might be an effective therapy for steroid-resistant renal allograft rejections. In contrast to RATG, alemtuzumab is nearly devoid of infusion-related side-effects. These data warrant a prospective trial.
authors.affiliation: Department of Nephrology, Radboud University Nijmegen Medical Center, the Netherlands. m.vandenhoogen@aig.umcn.nl
authors.forename: M W F
authors.initials: MW
authors.lastname: van den Hoogen
authors.forename: D A
authors.initials: DA
authors.lastname: Hesselink
authors.forename: W J
authors.initials: WJ
authors.lastname: van Son
authors.forename: W
authors.initials: W
authors.lastname: Weimar
authors.forename: L B
authors.initials: LB
authors.lastname: Hilbrands
mesh_terms: D000328:Adult; D000074323:Alemtuzumab; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control*; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D013256:Steroids / Q000627:therapeutic use*
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D013256:Steroids; D000074323:Alemtuzumab