Preliminary experience with alemtuzumab (Campath-1H) and low-dose tacrolimus immunosuppression in adult liver transplantation

Andreas G. Tzakis, Panagiotis Tryphonopoulos, Tomoaki Kato, Seigo Nishida, David M. Levi, Juan R. Madariaga, Jeffrey J. Gaynor, Werviston De Faria, Arie Regev, Violet Esquenazi, Debbie Weppler, Phillip Ruiz, Joshua Miller

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100 Scopus citations

Abstract

Background. The administration of alemtuzumab (Campath-1H [C1H]; Berlex Laboratories, Montville, NJ) at transplantation prevents a vigorous immune response and is believed to allow a gradual engagement of the host immune system. We report our preliminary experience with C1H and tacrolimus (Tac) immunosuppression in adult liver transplantation. Methods. We administered C1H and low-dose Tac to 40 adult recipients of cadaveric liver allografts between December 2001 and April 2003. A control group who met the same eligibility criteria consisted of 50 liver transplant recipients treated with our standard Tac and steroids protocol. Results. Baseline characteristics and patient and graft survival were similar (P>0.15). The incidence of acute rejection was significantly lower during the first 2 months posttransplantation (P=0.002) and slightly lower overall in the study group versus the control group at 12 months (46% vs. 55%, P=0.12, log-rank test). Median time to rejection among those experiencing rejection was significantly longer in the study group versus control group (2.76 vs. 0.34 months, P=0.0007). The mean Tac dose, 12-hr trough level, and percentage of patients receiving maintenance steroids were significantly lower in the group receiving C1H and Tac (P<0.0001 during the first 3 months, P<0.05 thereafter), as were the mean creatinine levels (P<0.05) and incidence of nephrotoxicity (P=0.004, conversion from Tac to other agents). Finally, in the group receiving C1H/Tac, patients with an average Tac trough level less than 6.5 ng/mL during the first 2 months posttransplantation demonstrated a significantly higher rejection rate beyond that time (P=0.02). Conclusion. C1H and low-dose Tac seems to be at least as effective as our standard Tac and steroids regimen in preventing acute rejection in adult liver allotransplantation with less renal toxicity and less use of maintenance steroids.

Original languageEnglish (US)
Pages (from-to)1209-1214
Number of pages6
JournalTransplantation
Volume77
Issue number8
DOIs
StatePublished - Apr 27 2004

ASJC Scopus subject areas

  • Transplantation

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    Tzakis, A. G., Tryphonopoulos, P., Kato, T., Nishida, S., Levi, D. M., Madariaga, J. R., Gaynor, J. J., De Faria, W., Regev, A., Esquenazi, V., Weppler, D., Ruiz, P., & Miller, J. (2004). Preliminary experience with alemtuzumab (Campath-1H) and low-dose tacrolimus immunosuppression in adult liver transplantation. Transplantation, 77(8), 1209-1214. https://doi.org/10.1097/01.TP.0000116562.15920.43