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Kenneth Wu

Kenneth Wu

Damai Specialist Hospital

Title: The Dilemma of Excessive T-lymphocyte Suppression

Biography

Trained in the United Kingdom, author, doctor, speaker and reviewer of medical journals, Dr Kenneth Wu completed his undergraduate education at Ninewells University Teaching Hospital prior to undergoing postgraduate research training at University of Leeds and University of Oxford. His tremendous passion in what he does has won him several awards including the British Royal College of Physicians Clinical Lesson Award and the British NHS Health Education Yorkshire Scholarship. His sub-specialty interests include immunosuppression in renal medicine and preventive medicine. Apart from being a consultant nephrologist, he is also a dynamic communicator and an inspiring writer. One of his most successful writings is an encouraging patient-focused book in preventive medicine which has now been translated to several languages and disseminated worldwide.

Abstract

There has been much interest in a number of renal transplant immunosuppressive agents in recent years. On the other hand, there is limited evidence to describe the efficacy and safety of the different strategies used. While significant risks exist in excessive lymphocyte suppression, alemtuzumab (AL), a humanized anti CD-52 antibody has been reported by some centres as a promising agent. A systematic review was carried out to evaluate the safety and efficacy of this monoclonal antibody. Studies which did not directly compare AL with another induction agent were excluded. Primary outcomes measured were acute rejection rate and patient survival. Other end points included were cytomegalovirus (CMV) infection rate and graft survival. Subgroup analysis was carried out to further compare the efficacy between AL, antithymocyte globulin (ATG) and interleukin antagonist (IL2A). As far as acute rejection is concern, AL is non-inferior to ATG and IL2A in the first year. Some of the studies even convincingly show AL is a favourable agent. As there is significant heteriogeneity (I2 more than 25%), qualitative summaries were used to complement this meta-analysis. We concluded AL is comparable to ATG and IL2A in preventing acute rejection. Despite its potent immunosuppressive efficacy, existing data supports it is a safe agent within the first year of renal transplant. Repeated dosing with AL is not implicated in patients with low risk of acute rejection.