AUTHOR=van Vugt Lukas K. , van der Zwan Marieke , Clahsen-van Groningen Marian C. , van Agteren Madelon , Hullegie-Peelen Daphne M. , De Winter Brenda C. M. , Reinders Marlies E. J. , Miranda Afonso Pedro , Hesselink Dennis A. 

TITLE=A Decade of Experience With Alemtuzumab Therapy for Severe or Glucocorticoid-Resistant Kidney Transplant Rejection

JOURNAL=Transplant International

VOLUME=36

YEAR=2023

URL=https://www.frontierspartnerships.org/journals/transplant-international/articles/10.3389/ti.2023.11834

DOI=10.3389/ti.2023.11834

ISSN=1432-2277

ABSTRACT=<p>Alemtuzumab is used as lymphocyte-depleting therapy for severe or glucocorticoid-resistant kidney transplant rejection. However, the long-term efficacy and toxicity of alemtuzumab therapy are unclear. Therefore, all cases of alemtuzumab anti-rejection therapy between 2012 and 2022 in our institution were investigated. Graft survival, graft function, lymphocyte depletion, serious infections, malignancies, and patient survival were analyzed and compared with a reference cohort of transplanted patients who did not require alemtuzumab anti-rejection therapy. A total of 225 patients treated with alemtuzumab were identified and compared with a reference cohort of 1,668 patients. Over 60% of grafts was salvaged with alemtuzumab therapy, but graft survival was significantly poorer compared to the reference cohort. The median time of profound T- and B lymphocyte depletion was 272 and 344 days, respectively. Serious infection rate after alemtuzumab therapy was 54.1/100 person-years. The risk of death (hazard ratio 1.75, 95%-CI 1.28–2.39) and infection-related death (hazard ratio 2.36, 95%-CI 1.35–4.11) were higher in the alemtuzumab-treated cohort. In conclusion, alemtuzumab is an effective treatment for severe kidney transplant rejection, but causes long-lasting lymphocyte depletion and is associated with frequent infections and worse patient survival outcomes.</p>