title: Alemtuzumab and minimization immunotherapy in kidney transplantation: long-term results of comparison with rabbit anti-thymocyte globulin and standard triple maintenance therapy.
abstract: BACKGROUND
  Efforts to improve long-term patient and allograft survival have included use of induction therapies as well as steroid and/or calcineurin inhibitor (CNI) avoidance/minimization.
  
  
  METHODS
  This is a retrospective review of kidney transplant recipients between September 2004 and July 2009. Immune minimization (group 1; n = 182) received alemtuzumab induction, low-dose CNI, and mycophenolic acid (MPA). Conventional immunosuppression (group 2; n = 232) received rabbit anti-thymocyte globulin, standard-dose CNI, MPA, and prednisone.
  
  
  RESULTS
  Both groups were followed up for same length of time (49.4 ± 21.7 months; P = .12). Patient survival was also similar (90% vs 94%; P = .14). Death-censored graft survival was inferior in group 1 compared with group 2 (86% vs 96%, respectively; P = .003). On multivariate analysis, group 1 was an independent risk factor for graft loss (aHR = 2.63; 95% confidence interval [CI], 1.32-5.26; P = .006). Biopsy-proven acute rejection occurred more in group 1, due to late rejections compared with group 2 (7% vs 2%; P < .01 respectively). Graft function was lower in group 1 compared with group 2 at 3 months (49.5 mL/mt vs 70.7 mL/mt, respectively; P < .001) to 48 months (48.6 mL/mt vs 69.4 mL/mt, respectively; P = .04).
  
  
  CONCLUSIONS
  Minimization of maintenance immunosuppression after alemtuzumab correlated with higher acute rejection and inferior graft survival compared with thymoglobulin and conventional triple immunotherapy.
authors: Department of Medicine/Division of Nephrology, SUNY at Buffalo, Buffalo, New York, USA. Electronic address: mzachari@ecmc.edu.
authors: M
authors: M
authors: Zachariah
authors: Department of Surgery, SUNY at Buffalo, Buffalo, New York, USA; Department of Anesthesiology, SUNY at Buffalo, Buffalo, New York, USA.
authors: N D
authors: ND
authors: Nader
authors: Department of Medicine/Division of Nephrology, SUNY at Buffalo, Buffalo, New York, USA.
authors: J
authors: J
authors: Brar
authors: Department of Medicine/Division of Nephrology, LSU, Shreveport, Louisiana, USA.
authors: N
authors: N
authors: Singh
authors: Department of Medicine/Division of Nephrology, SUNY at Buffalo, Buffalo, New York, USA.
authors: R
authors: R
authors: Venuto
authors: Department of Surgery, SUNY at Buffalo, Buffalo, New York, USA.
authors: S
authors: S
authors: Patel
authors: Department of Surgery, SUNY at Buffalo, Buffalo, New York, USA.
authors: M
authors: M
authors: Said
authors: Department of Surgery, SUNY at Buffalo, Buffalo, New York, USA.
authors: M R
authors: MR
authors: Laftavi
authors: Department of Medicine/Division of Nephrology, SUNY at Buffalo, Buffalo, New York, USA.
authors: O
authors: O
authors: Pankewycz
mesh_terms: D000328:Adult; D000074323:Alemtuzumab; D000818:Animals; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D000961:Antilymphocyte Serum / Q000627:therapeutic use; D001706:Biopsy; D065095:Calcineurin Inhibitors / Q000627:therapeutic use; D005260:Female; D005919:Glomerular Filtration Rate; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007167:Immunotherapy / Q000379:methods*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009173:Mycophenolic Acid / Q000627:therapeutic use; D011241:Prednisone / Q000627:therapeutic use; D016016:Proportional Hazards Models; D011817:Rabbits; D051437:Renal Insufficiency / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000961:Antilymphocyte Serum; D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D000074323:Alemtuzumab; D009173:Mycophenolic Acid; D011241:Prednisone