Alemtuzumab induction in renal transplantation permits safe steroid avoidance with tacrolimus monotherapy: a randomized controlled trial.
BACKGROUND
The use of alemtuzumab as induction immunosuppression for renal transplantation introduces the possibility of long-term tacrolimus monotherapy, avoiding maintenance with both corticosteroids and mycophenolate mofetil (MMF).


METHODS
We conducted a single-center, prospective, open-label, randomized controlled trial comparing two steroid avoidance regimens between December 2006 and November 2010. One hundred and sixteen adult patients were randomized to either basiliximab induction followed by tacrolimus and MMF maintenance or to alemtuzumab induction followed by tacrolimus monotherapy. The primary endpoint was noninferiority of isotopic glomerular filtration rate at 1 year; secondary endpoints included patient and graft survival, incidence of delayed graft function, and incidence and severity of biopsy-proven acute rejection.


RESULTS
The two groups were well matched for all baseline demographics. Isotopic glomerular filtration rate was comparable between the groups at 1 year (57±26 mL/min for alemtuzumab group and 53±21 mL/min for basiliximab group; P=0.42). Secondary endpoints were also similar between the groups. The rate of biopsy-proven acute rejection by 12 months was lower in the alemtuzumab group (n=6 vs. n=14 in basiliximab arm) just reaching statistical significance (P=0.049); however, a single extra case in the alemtuzumab arm included when considering clinically treated rejection removes this significance (P=0.082). Similar rates of cardiovascular, infective, and neoplastic complications were observed in both groups. Forty-seven (81.0%) of the patients in the alemtuzumab group remained on tacrolimus monotherapy at 12 months.


CONCLUSIONS
Renal transplantation with alemtuzumab induction followed by tacrolimus monotherapy leads to good graft and patient outcomes, with no major differences detected compared with basiliximab induction and tacrolimus/MMF maintenance at 1 year.
1 Department of Renal Medicine and Renal Transplantation, St. James's University Hospital, Leeds, UK. 2 Department of Transplant Surgery, St. James's University Hospital, Leeds, UK. 3 Department of Histopathology, St. James's University Hospital, Leeds, UK. 4 Address correspondence to: Richard J. Baker, M.B./B.Chir., M.A., Ph.D., F.R.C.P., Department of Renal Medicine and Renal Transplantation, St. James's University Hospital, Lincoln Wing, Beckett Street, Leeds LS9 7TF, UK.
Matthew P
MP
Welberry Smith
Aravind
A
Cherukuri
Chas G
CG
Newstead
Andrew J P
AJ
Lewington
Niaz
N
Ahmad
Krish
K
Menon
Stephen G
SG
Pollard
Padmini
P
Prasad
Steve
S
Tibble
Emma
E
Giddings
Richard J
RJ
Baker
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000074323:Alemtuzumab; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D000077552:Basiliximab; D001794:Blood Pressure; D003920:Diabetes Mellitus / Q000175:diagnosis; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects / Q000379:methods; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007668:Kidney / Q000187:drug effects; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D011446:Prospective Studies; D011788:Quality of Life; D011993:Recombinant Fusion Proteins / Q000627:therapeutic use; D013256:Steroids / Q000627:therapeutic use*; D016559:Tacrolimus / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D007166:Immunosuppressive Agents; D011993:Recombinant Fusion Proteins; D013256:Steroids; D000074323:Alemtuzumab; D000077552:Basiliximab; D009173:Mycophenolic Acid; D016559:Tacrolimus