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Dissociation of depletional induction and posttransplant lymphoproliferative disease in kidney recipients treated with alemtuzumab.

Publication ,  Journal Article
Kirk, AD; Cherikh, WS; Ring, M; Burke, G; Kaufman, D; Knechtle, SJ; Potdar, S; Shapiro, R; Dharnidharka, VR; Kauffman, HM
Published in: Am J Transplant
November 2007

Transplant patients are at the risk for posttransplant lymphoproliferative disease (PTLD), a virally-driven malignancy. Induction with the depleting antibody preparations Thymoglobulin and OKT3 is associated with PTLD suggesting that the T-cell depletion increases PTLD risk. We therefore studied 59 560 kidney recipients from the Organ Procurement and Transplantation Network/United Network for Organ Sharing (OPTN/UNOS) database for a relationship between induction agent use and PTLD. Two agents with comparable T-cell depletional effects, alemtuzumab and Thymoglobulin, were compared to nondepletional induction agents or no induction. The overall incidence of PTLD was 0.46% and differed significantly by induction strategy (p < 0.01): without induction (0.43%), basiliximab (0.38%), daclizumab (0.33%), Thymoglobulin (0.67%) and alemtuzumab (0.37%). Thymoglobulin was associated with significantly increased PTLD risk (p = 0.0025), but alemtuzumab (p = 0.74), basiliximab (p = 0.33) and daclizumab, which trended toward a protective effect (p = 0.06), were not. Alemtuzumab and Thymoglobulin treated patients did not differ in any established parameter affecting PTLD risk although alemtuzumab is known to have a more pronounced B-cell depleting effect. Interestingly, maintenance therapy with an mTOR inhibitor was strongly associated with PTLD (0.71%, p < 0.0001). Thus, depletional induction is not an independent risk factor for PTLD. Rather, maintenance drug selection or perhaps the balance between B- and T-cell depletion may be more relevant determinants of PTLD risk.

Duke Scholars

Published In

Am J Transplant

DOI

ISSN

1600-6135

Publication Date

November 2007

Volume

7

Issue

11

Start / End Page

2619 / 2625

Location

United States

Related Subject Headings

  • Time Factors
  • Surgery
  • Postoperative Complications
  • Lymphoproliferative Disorders
  • Lymphocyte Depletion
  • Kidney Transplantation
  • Immunosuppressive Agents
  • Humans
  • Follow-Up Studies
  • Drug Therapy, Combination
 

Citation

APA
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ICMJE
MLA
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Kirk, A. D., Cherikh, W. S., Ring, M., Burke, G., Kaufman, D., Knechtle, S. J., … Kauffman, H. M. (2007). Dissociation of depletional induction and posttransplant lymphoproliferative disease in kidney recipients treated with alemtuzumab. Am J Transplant, 7(11), 2619–2625. https://doi.org/10.1111/j.1600-6143.2007.01972.x
Journal cover image

Published In

Am J Transplant

DOI

ISSN

1600-6135

Publication Date

November 2007

Volume

7

Issue

11

Start / End Page

2619 / 2625

Location

United States

Related Subject Headings

  • Time Factors
  • Surgery
  • Postoperative Complications
  • Lymphoproliferative Disorders
  • Lymphocyte Depletion
  • Kidney Transplantation
  • Immunosuppressive Agents
  • Humans
  • Follow-Up Studies
  • Drug Therapy, Combination