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mTOR inhibitors avoid calcineurin nephrotoxicity, but sirolimus de novo is associated with unacceptable side effects and higher rejection rates. We have investigated a modified strategy: alemtuzumab induction with tacrolimus and mycophenolate maintenance, switching from tacrolimus to sirolimus at 6 months and stopping mycophenolate at 12 months. Here, we report the 6-year follow-up of 30 patients prospectively recruited to this single-arm pilot study and compare outcomes to a matched contemporaneous control group of 30 patients who received standard induction and calcineurin-inhibitor-based immunosuppression.Six-year patient and graft survival were 83% and 80%(alemtuzumab) versus 77% and 70% (control). Rejection rates in the first 6 months were similar in alemtuzumab (6.6%) and control groups (10%). A higher than expected incidence of rejection in the alemtuzumab group following cessation of mycophenolate at 1 year (17%) was mitigated in later patients by retaining low dose mycophenolate. Mean eGFR was higher in the alemtuzumab group at all time points but not significantly (p¼0.16). Tacrolimus levels in the first 6 months were significantly higher in the contemporaneous control group (p<0.001). Alemtuzumab induction with initial treatment with tacrolimus enables conversion to sirolimus without the side effects and incidence of acute rejection seen in earlier protocols.

Original publication

DOI

10.1111/ajt.12572

Type

Conference paper

Publication Date

03/2014

Volume

14

Pages

677 - 684

Keywords

Antibodies, Monoclonal, Humanized, Female, Follow-Up Studies, Glomerular Filtration Rate, Graft Rejection, Graft Survival, Humans, Immunosuppressive Agents, Kidney Failure, Chronic, Kidney Function Tests, Kidney Transplantation, Male, Middle Aged, Mycophenolic Acid, Pilot Projects, Postoperative Complications, Prognosis, Prospective Studies, Risk Factors, Sirolimus, Survival Rate