ISSN: 2475-7640

Journal of Clinical and Experimental Transplantation
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  • Research Article   
  • J Clin Exp Transplant 2017,
  • DOI: 10.4172/2475-7640.1000117

Alemtuzumab Equalizes Short Term Outcomes in High Risk PRA Patients: Long Term Outcomes Suffer

Naji M1#, Stanton AD1*#, Ekwenna O4, Mitro G1, Rees M2 and Jorge Ortiz3
1University of Toledo College of Medicine and Life Sciences, Toledo, Ohio, USA
2Departments of Urology and Pathology, University of Toledo College of Medicine and Life Sciences, Toledo, Ohio, USA
3Department of Surgery, University of Toledo College of Medicine and Life Sciences, Toledo, Ohio, USA
4University of Toledo medical center, , USA
#Contributed equally to this work
*Corresponding Author : Stanton AD, University of Toledo College of Medicine and Life Sciences, Toledo OH, 43606, USA, Tel: 248-421-0077, Email: Alexander.Stanton@rockets.utoledo.edu

Received Date: Sep 04, 2017 / Accepted Date: Sep 09, 2017 / Published Date: Sep 13, 2017

Abstract

Introduction: Alemtuzumab, a monoclonal antibody used in approximately 13% of kidney transplants, allows for early glucocorticoid withdrawal. High risk patients, defined by a presence of elevated Panel Reactive Antibody (PRA), are at greater risk for rejection, poorer graft outcomes, and have been shown to benefit from induction with alemtuzumab. The aim of this study is to assess the outcomes of immunologically sensitive kidney transplant recipients after induction with alemtuzumab and early steroid withdrawal.
Methods: A retrospective analysis of 668 transplant recipients, all receiving alemtuzumab induction, from March 2006 through November 2015 was performed. High risk patients (defined as elevated PRA >20%) were compared to those with a low PRA (PRA <20%). Outcomes, such as patient survival, graft survival, and rejection were assessed.
Results: Death-censored graft survival at 1-year was greater than 90% for both groups (p=0.343). Graft survival at 3- and 5- years was significantly lower in the high PRA group (3 years: 79.3%, 5 years: 73.2%) compared to the low PRA group (3 years: 91.3%, 5 years: 85.9%) (p=0.003, p=0.013). Overall death-censored graft survival for the high PRA group (77.6%) was also significantly lower than the low PRA group (87.5%, p=0.007). We noted no statistical difference between groups for other negative outcomes such as patient death or delayed graft function.
Conclusion: Alemtuzumab and subsequent steroid withdrawal is effective at reducing short term poor outcome disparities between high PRA and low PRA recipients. However, graft survival after the second year, and increasing rejection rates prior to the fifth year, demonstrates that the short term effectiveness of alemtuzumab does not translate into long term graft maintenance in patients with elevated PRA. This evidence suggests further investigation into the effectiveness of alemtuzumab induction with steroid withdrawal regimens in patients with an elevated PRA.

Keywords: Alemtuzumab; PRA; Immunosuppression

Citation: Naji M, Stanton AD, Ekwenna O, Mitro G, Rees M, et al. (2017) Alemtuzumab Equalizes Short Term Outcomes in High Risk PRA Patients: Long Term Outcomes Suffer. J Clin Exp Transplant 2: 117. Doi: 10.4172/2475-7640.1000117

Copyright: © 2017 Naji M, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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