Tags

Type your tag names separated by a space and hit enter

Kidney transplantation using alemtuzumab, belatacept, and sirolimus: Five-year follow-up.
Am J Transplant. 2020 Jun 08 [Online ahead of print]AJ

Abstract

Kidney transplant outcomes are limited by toxicities associated with calcineurin inhibitors and steroids. This trial was conducted to determine whether a costimulation blockade (CoB)-based regimen could achieve acceptable long-term outcomes and graft survival could be maintained solely with CoB. Forty patients underwent alemtuzumab induction followed by belatacept and sirolimus maintenance therapy. Patients were offered weaning to belatacept monotherapy after 1 year and followed for 5 years. Five-year patient and graft survival rates were 100% and 95%, respectively. Graft function remained stable with a mean estimated glomerular filtration rates of 67 ± 21 and 71 ± 19 at 36 and 60 months, respectively. There was no clinical rejection in the first year; subclinical rejection was detected by protocol biopsy in 4 patients. Twelve patients were successfully weaned to belatacept monotherapy. Cytomegalovirus and Epstein-Barr virus reactivations were well controlled, but 9 patients experienced transient BK viremia during the first year. Alemtuzumab produced profound lymphopenia followed by gradual T cell and more rapid B cell reconstitution to a repertoire deviated toward naïve cells with increased regulatory T cells. This regimen effectively prevents allograft rejection without using steroids or calcineurin inhibitors, enriches for naïve cells susceptible to control with CoB, and permits control of rejection with belatacept monotherapy in selected patients.

Authors+Show Affiliations

Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA.Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA.Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA.Emory Transplant Center, Emory University School of Medicine, Atlanta, Georgia, USA.Emory Transplant Center, Emory University School of Medicine, Atlanta, Georgia, USA.Emory Transplant Center, Emory University School of Medicine, Atlanta, Georgia, USA.Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32515087

Citation

Schmitz, Robin, et al. "Kidney Transplantation Using Alemtuzumab, Belatacept, and Sirolimus: Five-year Follow-up." American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons, 2020.
Schmitz R, Fitch ZW, Xu H, et al. Kidney transplantation using alemtuzumab, belatacept, and sirolimus: Five-year follow-up. Am J Transplant. 2020.
Schmitz, R., Fitch, Z. W., Xu, H., Ghali, A., Mehta, A. K., Guasch, A., & Kirk, A. D. (2020). Kidney transplantation using alemtuzumab, belatacept, and sirolimus: Five-year follow-up. American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons. https://doi.org/10.1111/ajt.16121
Schmitz R, et al. Kidney Transplantation Using Alemtuzumab, Belatacept, and Sirolimus: Five-year Follow-up. Am J Transplant. 2020 Jun 8; PubMed PMID: 32515087.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Kidney transplantation using alemtuzumab, belatacept, and sirolimus: Five-year follow-up. AU - Schmitz,Robin, AU - Fitch,Zachary W, AU - Xu,He, AU - Ghali,Ada, AU - Mehta,Aneesh K, AU - Guasch,Antonio, AU - Kirk,Allan D, Y1 - 2020/06/08/ PY - 2020/02/26/received PY - 2020/05/21/revised PY - 2020/05/28/accepted PY - 2020/6/10/pubmed PY - 2020/6/10/medline PY - 2020/6/10/entrez KW - clinical research/practice KW - clinical trial KW - costimulation KW - graft survival KW - immunosuppression/immune modulation KW - kidney transplantation/nephrology JF - American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons JO - Am. J. Transplant. N2 - Kidney transplant outcomes are limited by toxicities associated with calcineurin inhibitors and steroids. This trial was conducted to determine whether a costimulation blockade (CoB)-based regimen could achieve acceptable long-term outcomes and graft survival could be maintained solely with CoB. Forty patients underwent alemtuzumab induction followed by belatacept and sirolimus maintenance therapy. Patients were offered weaning to belatacept monotherapy after 1 year and followed for 5 years. Five-year patient and graft survival rates were 100% and 95%, respectively. Graft function remained stable with a mean estimated glomerular filtration rates of 67 ± 21 and 71 ± 19 at 36 and 60 months, respectively. There was no clinical rejection in the first year; subclinical rejection was detected by protocol biopsy in 4 patients. Twelve patients were successfully weaned to belatacept monotherapy. Cytomegalovirus and Epstein-Barr virus reactivations were well controlled, but 9 patients experienced transient BK viremia during the first year. Alemtuzumab produced profound lymphopenia followed by gradual T cell and more rapid B cell reconstitution to a repertoire deviated toward naïve cells with increased regulatory T cells. This regimen effectively prevents allograft rejection without using steroids or calcineurin inhibitors, enriches for naïve cells susceptible to control with CoB, and permits control of rejection with belatacept monotherapy in selected patients. SN - 1600-6143 UR - https://www.unboundmedicine.com/medline/citation/32515087/Kidney_Transplantation_using_Alemtuzumab,_Belatacept_and_Sirolimus_-_Five-Year_Follow-up L2 - https://doi.org/10.1111/ajt.16121 DB - PRIME DP - Unbound Medicine ER -
Try the Free App:
Prime PubMed app for iOS iPhone iPad
Prime PubMed app for Android
Prime PubMed is provided
free to individuals by:
Unbound Medicine.