INDUCTION IMMUNOSUPPRESSION

Y.A. Baez, F.A. Giron
Organ Transplant, Colombiana de Trasplantes, Bogota/COLOMBIA

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Introduction Alemtuzumab (Campath-1H) is a monoclonal antibody directed against CD52, an antigen expressed on all blood mononuclear cells. Its mechanism of action includes complement-mediated cytolysis, antibody-mediated cytotoxicity and apoptosis. The use of Alemtuzumab for induction therapy in kidney transplantation has been increasing in the world. We evaluated the role of Alemtuzumab induction in Hispanic population. Methods A total of 200 consecutive deceased or living kidney transplants from 2006 to 2007 received a single infusion of alemtuzumab (Campath-1H) 30 mg (0.4mg/kg in pediatric patients) intravenous, plus reduced dose maintenance inmmunosuppression therapy and steroid-free to 1 year of follow-up (see table 1). The maintenance immunosuppression regimen given to recipients consisted of a calcineurin inhibitors (CNI) and antiproliferative agent (mycophenolate mofetil or acid). We used posttransplantation low- dose cyclosporine (target trough of 400- 600ng/ml C2) or Tacrolimus (target 5-7 ng/ml C0) depending immunologic risk. 100 patients (Group 1) received reduced dose of mycophenolate mofetil (MMF) 1.5 g/day or mycophenolate acid (MPA) 1.040 mg/day. Another consecutive 100 patients (Group 2) we increased mycophenolate dose MMF (2 gr day) and MPA (1.440 mg/day) at third month and other immunosuppression was not change. Results In the Group 1, the cumulative incidences of biopsy – proven acute rejection (BPAR) at 1,3,6 and 12 months were 0%, 4%,9% and 17% respectively. In the another group (Group 2), the cumulative incidences of biopsy – proven acute rejection(BPAR) at 1, 3, 6, and 12 months were 0%, 5%, 6% and 8% , p < 0.05. (0,13-0,95). Most episodes of ACR were Banff 1 (a or b) and were sensitive to steroid pulses for the treatment of rejection. Posttransplant complications infectious were 11% and 9% UTI (urinary tract infection). Conclusion Higher rate of later rejection (3-6 month) observed in Alemtuzumab induction therapy could reflects inadequate maintenance immunosuppression exposure when lymphocyte repopulation would be anticipated. Modification of immunosuppression after recovery of recipient lynphodepletion can be the approach.

Disclosure: All authors have declared no conflicts of interest.