TO WEAN OR NOT TO WEAN TACROLIMUS MONOTHERAPY AFTER ALEMTUZUMAB PRETREATMENT IN LIVING DONOR KIDNEY TRANSPLANT RECIPIENTS: A COMPARATIVE STUDY.

INDUCTION IMMUNOSUPPRESSION

H.P. Tan¹, A. Chaudhary², A. Humar³, J. Donaldson¹, A. Basu¹, C. Morgan¹, M. Unruh⁴, J. Mccauley⁴, C. Wu⁴, N. Shah⁵, P. Randhawa⁶, R. Shapiro^1
1Surgery / Transplant, Thomas E. Starzl Transplantation Institute, Pittsburgh/PA/UNITED STATES OF AMERICA, ²Transplant Surgery, Thomas E. Starzl Transplantation Institute, Pittsburgh/PA/UNITED STATES OF AMERICA, ³Department Of Surgery, Thomas E. Starzl Transplantation Institute, Pittsburgh/PA/UNITED STATES OF AMERICA, ⁴Nephrology, UPMC, Pittsburgh/PA/UNITED STATES OF AMERICA, ⁵Internal Medicine/nephrology, UPMC, Pittsburgh/PA/UNITED STATES OF AMERICA, ⁶Pathology, UPMC, Pittsburgh/PA/UNITED STATES OF AMERICA

Body: Introduction: To determine the consequence of weaning or not weaning of tacrolimus monotherapy in living donor kidney transplantation (LDKT) performed under alemtuzumab (Campath-1H, anti-CD52) pretreatment.

Methods: We used clinical data (including ELISA antibody titers, Cylex T cell activation assays, identification of DSA, and C4d stains) to wean Tacrolimus when possible at 6 months post transplant and every 2 to 6 months interval (bid-->qd-->qod-->tiw-->biw-->qwk). Spaced weaning was put on temporary hold beginning in Mar 2007. We compared our results with a matched group of the same number of patients in whom weaning and no weaning of tacrolimus monotherapy was attempted and the advantages and disadvantages of this strategy were evaluated, with a particular emphasis on recipient death, graft loss, graft function and acute rejection characteristics.

Results:

	Weaning of Tacrolimus Monotherapy	Tacrolimus Monotherapy Not Weaned
Total number of patients	150	149
Adult	136 (90.7%)	120 (80.7%)
Pediatric	14 (9.3%)	29 (19.3%)
Transplants performed between	5/16/05 to 2/28/07	3/5/07 to 3/11/09
Mean follow up time (months)	41.8 ±23.7	20.4 ± 7.8
Age (Yrs)	42.9 ±18.70	40.6 ±20.79
Female	49 (32.7%)	51 (34.0%)
African American	18 (12.0%)	7 (4.7%)
>= 70 yrs old	10 (6.7%)	11 (7.3%)
Re-transplants	25 (16.7%)	20 (13.3%)
1 YR Survival (Pat / Graft)	97.3% / 97.3%	97.9% / 96.0%
2 YR Survival (Pat / Graft)	94.0% / 90.0%	97.9% / 95.0%
Creat 1 YR (n=145)	1.47 ±0.60	1.32 ±0.47
Creat 2 YR (n=134)	1.59 ±0.88	1.33 ±0.50
GFR 1 YR (n=145)	57.4 ±20.4	63.3 ±29.1
GFR 2 YR (n=134)	53.7 ±19.3	62.0 ±28.9
GFR 3 YR (n=125)	52.7 ±20.1	--
GFR 4 YR (n=65)	54.7 ±17.6	--
Acute rejection at 1YR	8.7%	7.3%
Acute rejection at 2YR	16.7%	11.3%
Recipients on or more maintenance immunosuppression therapy (eg tacrolimus plus MMF)	22 (14.7%)	17 (11.4%)

Conclusion: LDKT recipients on tacrolimus monotherapy who were not weaned had slightly better patient and graft survivals, lesser ACR incidence, better long term creatinine and GFR. Most recipients could be maintained on tacrolimus monotherapy.

Disclosure: All authors have declared no conflicts of interest.