Campath induction and steroid avoidance in pancreas transplantation - The Oxford transplant centre experience in 231 patients

Purpose: To study the impact of Campath induction in pancreas transplantation, with particular reference to steroid avoidance. Methods: Campath (alemtuzumab) is a humanised anti-CD52 T & B-cell depleting antibody, clinically effective in many immune-mediated disorders. From August 2004 to November 2008, 234 pancreas transplants were performed in 231 patients receiving Campath induction (175 simultaneous pancreas kidney (SPK), 37 pancreas after kidney (PAK) and 37 pancreas transplant alone (PTA)). 25 transplants (2 SPK, 12 PAK, 12 PTA) were from donors after cardiac death. 30 mg of Campath was given either IV (n=193) or subcutaneously (n=41) on day 0 & 1 with tacrolimus (trough level 8-12ng/ml) and mycophenolate mofetil for maintenance immunosuppression. Methyl prednisolone was given IV before reperfusion of the grafts. No steroids were used in the maintenance regimen. Patient and graft survival, rejection rate and adverse events were recorded. Results: The median length of follow-up was 18 months (range 0-53 months) in 140 males and 94 females with a median age of 43 (range 25-67). Overall patient survival was 97%. 96 % of SPK patients are currently off dialysis and 88% of all pancreas recipients have a functioning pancreas graft. 17% received treatment for rejection. 4 patients (8%) developed BK viruria, but still have functioning renal grafts. Viral infections included CMV (5.9%), varicella zoster (1.7%), herpes simplex (1.3%) and parvovirus (0.4%). 24% of patients required re-operation. 12.3% developed neutropenia and 1.7% received granulocyte-colony stimulating factor. 89.4% have received no steroids post-transplant and 7 patients (3%) are currently on steroids. 3 patients (2 SPK & 1 PAK) developed post-transplant lymphoproliferative disorder and have responded to immunosuppression reduction and have functional grafts. Conclusions: Campath is safe and enables pancreas transplantation with acceptable rejection rates and without the need for steroid maintenance in 89% of cases.