title: Induction therapy with alemtuzumab (campath) in combined liver-kidney transplantation: University of Bologna experience.
abstract: BACKGROUND
  Combined liver-kidney transplantation (LKT) is considered to be a safe procedure, but the appropriate immunosuppressive regimen is unclear.
  
  
  METHODS
  Between January 1997 and October 2011, 55 patients were listed for LKT: 45 (82%) were effectively transplanted, 5 (9.2%) died whereon here the waiting list, 3 (5.5%) temporarily out of waiting list, 1 (1.8%) was on waiting list and 1 (1.8%) refused LKT. Five LKTs treated with cyclosporine (CyA) were excluded from the analysis. Mean recipient age was 50.32 ± 10.32 years (14-65), MELD score at time of LKT was 19.22 ± 4.69 (8-29), mean waiting list time was 8.14 ± 9.50 months (0.1-35.76), and follow-up, 4.09 ± 3.02 years (0.01-10.41). Main indications for LKT were policystic disease (n = 15; 37%), hepatitis virus C (HCV)-related cirrhosis (n = 9; 22%) metabolic disease (n = 5; 13%), hepatitis virus B (HBV) cirrhosis (n = 4; 10%), alcoholic cirrhosis (n = 4; 10%), and cholestatic disease (n = 3; 8%). Immunosuppressive regimen was based on tacrolimus and steroids in 40 cases with induction therapy with alemtuzumab (Campath; 0.3 mg/kg) in 13 of 40 instances cases administered on day 0 and day 7.
  
  
  RESULTS
  Postoperative mortality was 2.5%. Acute cellular rejection episodes were biopsy-proven in 2 (5%) cases, post-LKT infections developed in 17 cases (42.5%), and de novo cancer developed in 3 (7.5%) cases. Similar 5-year overall survivals were obtained irrespective of the LKT indication: 100% in cholestatic and alcoholic cirrhosis patients, 86% in policystic disease, 75% in metabolic disease and HBV patients, and 66% in HCV cirrhosis. Overall survivals for the alemtuzumab vs without-induction therapy groups at 1, 3, and 5-years were 100%, 85.7%, and 85.7% vs 76%, 76%, and 70%, respectively (P = .04).
  
  
  CONCLUSIONS
  An immunosuppressive regimen based on tacrolimus and steroids with induction therapy with alemtuzumab was safe, with excellent long-term results for combined LKT.
authors.affiliation: General and Transplantation Surgery Unit, Prof. A.D. Pinna, S. Orsola Hospital, University of Bologna, Bologna, Italy. massimo.delgaudio@aosp.bo.it
authors.forename: M
authors.initials: M
authors.lastname: Del Gaudio
authors.forename: M
authors.initials: M
authors.lastname: Ravaioli
authors.forename: G
authors.initials: G
authors.lastname: Ercolani
authors.forename: M
authors.initials: M
authors.lastname: Cescon
authors.forename: A
authors.initials: A
authors.lastname: Amaduzzi
authors.forename: F
authors.initials: F
authors.lastname: Neri
authors.forename: S
authors.initials: S
authors.lastname: Pellegrini
authors.forename: G
authors.initials: G
authors.lastname: Feliciangeli
authors.forename: G
authors.initials: G
authors.lastname: Lamanna
authors.forename: C
authors.initials: C
authors.lastname: Morelli
authors.forename: G Liviano
authors.initials: GL
authors.lastname: D'Arcangelo
authors.forename: G
authors.initials: G
authors.lastname: Comai
authors.forename: M
authors.initials: M
authors.lastname: Cucchi
authors.forename: S
authors.initials: S
authors.lastname: Stefoni
authors.forename: A D
authors.initials: AD
authors.lastname: Pinna
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000074323:Alemtuzumab; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007558:Italy; D016030:Kidney Transplantation; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D014850:Waiting Lists; D055815:Young Adult
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D000074323:Alemtuzumab