Long-term outcomes following alemtuzumab induction in lung transplantation.
OBJECTIVE
Alemtuzumab is a commonly used induction agent for solid-organ transplantation. Its use in lung transplantation with reduced immunosuppressive regimens, however, has yet to be well characterized.


METHODS
From November 2006 to March 2008, 20 consecutive lung transplantation patients received alemtuzumab induction with a reduced maintenance immunosuppression regimen. Twenty consecutive case-controls who underwent transplantation between 2005 and 2006 were treated with a standard immunosuppression regimen without induction. Outcome variables were patient survival, acute rejection, infection, and bronchiolitis obliterans syndrome.


RESULTS
Mean follow-up time was 1400 days in the alemtuzumab group and 1210 days in the control group. Double lung transplantation was performed in 21 patients (12 in the alemtuzumab group and 9 in the control group). There was no difference in survival between the alemtuzumab (n = 10) and control (n = 10) groups. There was also not a significant difference in time-adjusted death based on Kaplan-Meier analysis. The mean number of any grade of rejection event per patient was not significantly different (alemtuzumab 2.3 ± 2.7 vs. control 3.2 ± 2.35; P = .22). There was a trend toward the reduced incidence of infection requiring intravenous antibiotics per patient (alemtuzumab 2.4 vs. control 3.8; P = .08). The incidence of bronchiolitis obliterans syndrome was similar in both groups (alemtuzumab 55% vs. control 70%; P = .25).


CONCLUSIONS
Alemtuzumab induction with reduced immunosuppression offers a comparable 5-year survival and rejection rate compared to standard-dose immunosuppression regimen.
Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.
Brody
B
Wehman
Bartley P
BP
Griffith
Akshu
A
Balwan
Zachary N
ZN
Kon
Dante A
DA
Suffredini
Charles
C
Evans
Jose P
JP
Garcia
Aldo
A
Iacono
D000074323:Alemtuzumab; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D018572:Disease-Free Survival; D005260:Female; D006084:Graft Rejection / Q000401:mortality* / Q000517:prevention & control*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015994:Incidence; D008137:Longitudinal Studies; D008171:Lung Diseases / Q000401:mortality* / Q000601:surgery*; D016040:Lung Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011292:Premedication / Q000401:mortality*; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome
D061067:Antibodies, Monoclonal, Humanized; D007166:Immunosuppressive Agents; D000074323:Alemtuzumab