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Alemtuzumab induction and recurrence of glomerular disease after kidney transplantation.

Publication ,  Journal Article
Pascual, J; Mezrich, JD; Djamali, A; Leverson, G; Chin, LT; Torrealba, J; Bloom, D; Voss, B; Becker, BN; Knechtle, SJ; Sollinger, HW ...
Published in: Transplantation
June 15, 2007

BACKGROUND: An increase in the incidence of autoimmune diseases has been described in patients receiving alemtuzumab. METHODS: To determine whether induction with alemtuzumab increases recurrence of glomerular disease, we performed a retrospective study in 443 patients with biopsy-proven glomerular diseases undergoing kidney transplantation. Patients receiving alemtuzumab (n=161) were compared with those receiving interleukin (IL)-2-receptor antagonists (n=217) or antithymocyte globulin (n=64). RESULTS: Biopsy-proven glomerular disease recurrence was similar in patients induced with alemtuzumab or IL-2 receptor antagonists. Patients receiving antithymocyte antibody had a lower recurrence rate than patients treated with other induction agents, with borderline significance (hazard ratio [HR] 0.13, 95% confidence interval [95% CI] 0.02-0.98, P=0.047). Patients with systemic lupus treated with alemtuzumab had a similar re-emergence of autoreactive antibodies to patients treated with other agents. Recurrent disease increased the risk of allograft failure (HR 2.36, 95% CI 1.28-4.32, P=0.0056). The development of acute rejection and the use of deceased (vs. living) donor kidneys were also significant factors influencing graft survival. A greater risk of mortality was detected in those patients with recurrent glomerular disease (HR 3.76, 95% CI 1.37-10.35, P=0.01), whereas increased age at transplantation (HR 1.05) and the use of deceased (vs. living) donor kidneys (HR 3.20) also increased mortality. No specific induction agent significantly affected graft loss or mortality when using adjusted or unadjusted hazard ratios. CONCLUSIONS: In this retrospective analysis, induction with alemtuzumab did not increase the rate of re-emergence of autoantibodies or biopsy-proven recurrence of glomerular disease. A slight reduction in the incidence of recurrence was observed in patients treated with thymoglobulin, yet this observation can only be validated in a prospective randomized trial.

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Published In

Transplantation

DOI

ISSN

0041-1337

Publication Date

June 15, 2007

Volume

83

Issue

11

Start / End Page

1429 / 1434

Location

United States

Related Subject Headings

  • Survival Analysis
  • Surgery
  • Secondary Prevention
  • Risk Assessment
  • Retrospective Studies
  • Receptors, Interleukin-2
  • Middle Aged
  • Male
  • Lupus Erythematosus, Systemic
  • Living Donors
 

Citation

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MLA
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Pascual, J., Mezrich, J. D., Djamali, A., Leverson, G., Chin, L. T., Torrealba, J., … Samaniego, M. D. (2007). Alemtuzumab induction and recurrence of glomerular disease after kidney transplantation. Transplantation, 83(11), 1429–1434. https://doi.org/10.1097/01.tp.0000264554.39645.74
Pascual, Julio, Joshua D. Mezrich, Arjang Djamali, Glen Leverson, L Thomas Chin, José Torrealba, Debra Bloom, et al. “Alemtuzumab induction and recurrence of glomerular disease after kidney transplantation.Transplantation 83, no. 11 (June 15, 2007): 1429–34. https://doi.org/10.1097/01.tp.0000264554.39645.74.
Pascual J, Mezrich JD, Djamali A, Leverson G, Chin LT, Torrealba J, et al. Alemtuzumab induction and recurrence of glomerular disease after kidney transplantation. Transplantation. 2007 Jun 15;83(11):1429–34.
Pascual, Julio, et al. “Alemtuzumab induction and recurrence of glomerular disease after kidney transplantation.Transplantation, vol. 83, no. 11, June 2007, pp. 1429–34. Pubmed, doi:10.1097/01.tp.0000264554.39645.74.
Pascual J, Mezrich JD, Djamali A, Leverson G, Chin LT, Torrealba J, Bloom D, Voss B, Becker BN, Knechtle SJ, Sollinger HW, Pirsch JD, Samaniego MD. Alemtuzumab induction and recurrence of glomerular disease after kidney transplantation. Transplantation. 2007 Jun 15;83(11):1429–1434.

Published In

Transplantation

DOI

ISSN

0041-1337

Publication Date

June 15, 2007

Volume

83

Issue

11

Start / End Page

1429 / 1434

Location

United States

Related Subject Headings

  • Survival Analysis
  • Surgery
  • Secondary Prevention
  • Risk Assessment
  • Retrospective Studies
  • Receptors, Interleukin-2
  • Middle Aged
  • Male
  • Lupus Erythematosus, Systemic
  • Living Donors