Alemtuzumab induction in pancreas transplantation

A. Rathnasamy Muthusamy¹, A. Vaidya¹, S. Sinha¹, I. Quiroga¹, J. Gilbert¹, S. Reddy¹, E. Sharples², P. Friend^3
1 Oxford Transplant Centre, Transplant Surgery, Oxford, U.K.; ² Oxford Transplant Centre, Transplant Nephrology, Oxford, U.K.; ³ University of Oxford, Oxford, U.K.

Objective: Alemtuzumab is a humanized anti-CD52 depleting antibody witheffects on T & B lymphocytes. The efficacy and safety of alemtuzumab-basedimmunosuppression and its ability to achieve steroid-free maintenance wasanalyzed retrospectively.

Methods: 407 consecutive pancreas transplants performed withsystemic-enteric drainage between June 2004 and February 2011 were analyzed.Patients received alemtuzumab 30mg on day 0 & 1 with methyl prednisolone500mg, and tacrolimus (target trough 8-12 ng/ml) & Mycophenolate mofetil(1-1.5g/day) as maintenance immunosuppression. Patient, graft survival andcomplications were analyzed.

Results: 390 of the 407 pancreases (96%) received alemtuzumab inductionresulting in 288 SPK, 55 PTA, and 47 PAK including 9 re-transplants. 50 grafts(13%) originated from DCD. Median (range) recipient age and BMI were 43 years(23-67) & 23(16.5-37). Median cold ischemia was 11hrs 30 min and hospitalstay, 14 days. With 32-month median follow-up (range 1-80), overall patient,pancreas and kidney graft survival were 93%, 82% and 88%. DGF occurred in 15%of kidneys & 4% pancreases. Pancreas grafts were lost to chronic rejection(5%), DWFG (5%), pancreatitis (3%), thrombosis (2%, mostly DCD), bleeding(0.5%), leak (0.5%), and staple failure (0.5%). Renal grafts were lost to DWFG(5%), thrombosis (2%), rejection (2%), non-function (0.7%), BKV (0.2%), andPTLD (0.2%). Rejection episodes (11%) were treated with corticosteroids; 2% developedvascular rejection. 25% recipients had reoperations. Other complicationsinclude neutropenia (2.6%), viral (CMV 3.6%, varicella zoster 1.3%, herpessimplex 0.5%), bacterial (6.4%), and fungal (4%) infections. PTLD occurred in0.7%. 40 patients (10%) received single dose only (bleeding- 4%, low platelets - 1.5%, rash – 1.5%, age >60– 1.5%, others – 1.5%). 89% recipients never received any maintenance steroids.

Conclusion: Our results suggest that alemtuzumab is safe and efficacious, enablingsteroid free maintenance in 89% of pancreas transplant recipients.