Campath-1H induction therapy in African American and hispanic first renal transplant recipients: 3-year actuarial follow-up

Gaetano Ciancio, George W Burke, Jeffrey Gaynor, Junichiro Sageshima, Eva Herrada, Lissett Tueros, David Roth, Warren Kupin, Anne Rosen, Violet Esquenazi, Joshua Miller

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Background. In a retrospective study of the first 75 primary renal transplant patients given alemtuzumab induction at our center, 20 were African American (27%), 32 were Hispanic (43%), and 23 were non-African American, non- Hispanic (31%). Methods. Alemtuzumab was given intraoperatively and 4 days later (0.3 mg/kg), with planned low-dose maintenance mycophenolate mofetil (500 mg twice daily) and tacrolimus (targeted trough levels of 5 to 7 ng/ml) and no corticosteroid therapy after the first week. Median follow-up among ongoing survivors with a functioning graft was 45 months. Results. Three-year actuarial patient and graft survival rates were 95% and 85% in African Americans, 89% and 78% in Hispanics, and 96% and 96% in non-African Americans, non-Hispanics, respectively (not significant). Bioavailability of tacrolimus was significantly lower among African Americans in comparison with the other patient subgroups (P≤.002). While the incidence of biopsy-proven acute rejection was 20% (4/20) in African Americans, 19% (6/32) in Hispanics, and 13% (3/23) in non-African American, non-Hispanic (not significant), chronic allograft dysfunction occurred more frequently among African Americans (10/20) in comparison with Hispanics (8/32) and non-African American, non-Hispanics (8/23) (P=0.08, log-rank test). In addition, there was a trend at 6 and 12 months posttransplant for the mean serum creatinine to be less favorable among African American patients (P=0.08 and 0.07). No group had increased infection or malignancy. Conclusions. This immunosuppressive protocol appears reasonably safe for 3 years after renal transplantation but suggests higher incidences of biopsy-proven acute rejection, chronic allograft dysfunction, and borderline poorer renal function among African Americans in comparison with the other patient subgroups.

Original languageEnglish
Pages (from-to)507-516
Number of pages10
JournalTransplantation
Volume85
Issue number4
DOIs
StatePublished - Dec 1 2008

Fingerprint

Hispanic Americans
African Americans
Kidney
Tacrolimus
Therapeutics
Allografts
Mycophenolic Acid
Transplants
Biopsy
Transplant Recipients
alemtuzumab
Incidence
Graft Survival
Immunosuppressive Agents
Kidney Transplantation
Biological Availability
Survivors
Creatinine
Adrenal Cortex Hormones
Survival Rate

Keywords

  • African-Americans
  • Hispanics
  • Induction therapy
  • Kidney transplantation
  • Mycophenolate mofetil
  • Racial minorities
  • Steroid avoidance
  • Tacrolimus

ASJC Scopus subject areas

  • Transplantation
  • Immunology

Cite this

Campath-1H induction therapy in African American and hispanic first renal transplant recipients : 3-year actuarial follow-up. / Ciancio, Gaetano; Burke, George W; Gaynor, Jeffrey; Sageshima, Junichiro; Herrada, Eva; Tueros, Lissett; Roth, David; Kupin, Warren; Rosen, Anne; Esquenazi, Violet; Miller, Joshua.

In: Transplantation, Vol. 85, No. 4, 01.12.2008, p. 507-516.

Research output: Contribution to journalArticle

Ciancio, Gaetano ; Burke, George W ; Gaynor, Jeffrey ; Sageshima, Junichiro ; Herrada, Eva ; Tueros, Lissett ; Roth, David ; Kupin, Warren ; Rosen, Anne ; Esquenazi, Violet ; Miller, Joshua. / Campath-1H induction therapy in African American and hispanic first renal transplant recipients : 3-year actuarial follow-up. In: Transplantation. 2008 ; Vol. 85, No. 4. pp. 507-516.
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T1 - Campath-1H induction therapy in African American and hispanic first renal transplant recipients

T2 - 3-year actuarial follow-up

AU - Ciancio, Gaetano

AU - Burke, George W

AU - Gaynor, Jeffrey

AU - Sageshima, Junichiro

AU - Herrada, Eva

AU - Tueros, Lissett

AU - Roth, David

AU - Kupin, Warren

AU - Rosen, Anne

AU - Esquenazi, Violet

AU - Miller, Joshua

PY - 2008/12/1

Y1 - 2008/12/1

N2 - Background. In a retrospective study of the first 75 primary renal transplant patients given alemtuzumab induction at our center, 20 were African American (27%), 32 were Hispanic (43%), and 23 were non-African American, non- Hispanic (31%). Methods. Alemtuzumab was given intraoperatively and 4 days later (0.3 mg/kg), with planned low-dose maintenance mycophenolate mofetil (500 mg twice daily) and tacrolimus (targeted trough levels of 5 to 7 ng/ml) and no corticosteroid therapy after the first week. Median follow-up among ongoing survivors with a functioning graft was 45 months. Results. Three-year actuarial patient and graft survival rates were 95% and 85% in African Americans, 89% and 78% in Hispanics, and 96% and 96% in non-African Americans, non-Hispanics, respectively (not significant). Bioavailability of tacrolimus was significantly lower among African Americans in comparison with the other patient subgroups (P≤.002). While the incidence of biopsy-proven acute rejection was 20% (4/20) in African Americans, 19% (6/32) in Hispanics, and 13% (3/23) in non-African American, non-Hispanic (not significant), chronic allograft dysfunction occurred more frequently among African Americans (10/20) in comparison with Hispanics (8/32) and non-African American, non-Hispanics (8/23) (P=0.08, log-rank test). In addition, there was a trend at 6 and 12 months posttransplant for the mean serum creatinine to be less favorable among African American patients (P=0.08 and 0.07). No group had increased infection or malignancy. Conclusions. This immunosuppressive protocol appears reasonably safe for 3 years after renal transplantation but suggests higher incidences of biopsy-proven acute rejection, chronic allograft dysfunction, and borderline poorer renal function among African Americans in comparison with the other patient subgroups.

AB - Background. In a retrospective study of the first 75 primary renal transplant patients given alemtuzumab induction at our center, 20 were African American (27%), 32 were Hispanic (43%), and 23 were non-African American, non- Hispanic (31%). Methods. Alemtuzumab was given intraoperatively and 4 days later (0.3 mg/kg), with planned low-dose maintenance mycophenolate mofetil (500 mg twice daily) and tacrolimus (targeted trough levels of 5 to 7 ng/ml) and no corticosteroid therapy after the first week. Median follow-up among ongoing survivors with a functioning graft was 45 months. Results. Three-year actuarial patient and graft survival rates were 95% and 85% in African Americans, 89% and 78% in Hispanics, and 96% and 96% in non-African Americans, non-Hispanics, respectively (not significant). Bioavailability of tacrolimus was significantly lower among African Americans in comparison with the other patient subgroups (P≤.002). While the incidence of biopsy-proven acute rejection was 20% (4/20) in African Americans, 19% (6/32) in Hispanics, and 13% (3/23) in non-African American, non-Hispanic (not significant), chronic allograft dysfunction occurred more frequently among African Americans (10/20) in comparison with Hispanics (8/32) and non-African American, non-Hispanics (8/23) (P=0.08, log-rank test). In addition, there was a trend at 6 and 12 months posttransplant for the mean serum creatinine to be less favorable among African American patients (P=0.08 and 0.07). No group had increased infection or malignancy. Conclusions. This immunosuppressive protocol appears reasonably safe for 3 years after renal transplantation but suggests higher incidences of biopsy-proven acute rejection, chronic allograft dysfunction, and borderline poorer renal function among African Americans in comparison with the other patient subgroups.

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KW - Hispanics

KW - Induction therapy

KW - Kidney transplantation

KW - Mycophenolate mofetil

KW - Racial minorities

KW - Steroid avoidance

KW - Tacrolimus

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