title: Alemtuzumab induction and antibody-mediated rejection in kidney transplantation.
abstract: BACKGROUND
  Induction therapy improves graft outcomes in kidney transplant recipients (KTRs). We aimed to compare the incidences of antibody-mediated rejection (AMR) and acute cellular rejection (ACR) as well as graft and patient outcomes in KTRs who underwent induction with alemtuzumab versus rabbit-antithymocyte globulin (r-ATG).
  
  
  METHODS
  This was a single-center retrospective study involving patients who underwent kidney transplantation between January 2009 and December 2011 after receiving induction therapy with either alemtuzumab or r-ATG. Maintenance immunosuppression included tacrolimus and mycophenolate mofetil with early steroid withdrawal. Acute rejection was diagnosed using allograft biopsy.
  
  
  RESULTS
  Among the 108 study patients, 68 received alemtuzumab and 40 got r-ATG. There was a significantly higher incidence of AMR (15% vs 2.5%; P = .008) and similar incidence of ACR (4.4% vs 10%; P = .69) for alemtuzumab versus r-ATG groups. One-year serum creatinine levels (l.68 ± 0.8 mg/dL vs 1.79 ± 1.8 mg/dL; P = .66) as well as graft (91.1 ± 3.5% vs 94.5 ± 3.8%; P = .48) and patient (93.8 ± 3.0% vs 96.4 ± 3.5%; P = .92) survivals were similar for the alemtuzumab versus the r-ATG groups.
  
  
  CONCLUSIONS
  Our study showed a higher incidence of AMR and similar incidence of ACR in KTRs who underwent induction with alemtuzumab compared with those who received r-ATG and were maintained on tacrolimus and MMF. This was despite a lower HLA mismatch in the alemtuzumab group. One-year graft survival, patient survival, and allograft function were similar. Inadequate B-cell suppression by alemtuzumab as well as altered phenotypic and functional properties of repopulating B cells could be contributing to heightened risk of AMR in these patients.
authors.affiliation: Division of Nephrology and Hypertension, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA.
authors.forename: T
authors.initials: T
authors.lastname: Noureldeen
authors.affiliation: Division of Nephrology and Hypertension, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA.
authors.forename: Z
authors.initials: Z
authors.lastname: Albekioni
authors.affiliation: Division of Nephrology and Hypertension, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA.
authors.forename: L
authors.initials: L
authors.lastname: Machado
authors.affiliation: Division of Nephrology and Hypertension, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA.
authors.forename: N
authors.initials: N
authors.lastname: Muddana
authors.affiliation: Division of Nephrology and Hypertension, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA.
authors.forename: R J
authors.initials: RJ
authors.lastname: Marcus
authors.affiliation: Division of Nephrology and Hypertension, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA.
authors.forename: S M
authors.initials: SM
authors.lastname: Hussain
authors.affiliation: Division of Nephrology and Hypertension, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA. Electronic address: ksureshk@wpahs.org.
authors.forename: K K
authors.initials: KK
authors.lastname: Sureshkumar
mesh_terms: D000074323:Alemtuzumab; D061067:Antibodies, Monoclonal, Humanized / Q000494:pharmacology*; D000970:Antineoplastic Agents / Q000494:pharmacology; D001402:B-Lymphocytes / Q000187:drug effects / Q000276:immunology; D005260:Female; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control*; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D000074323:Alemtuzumab