Shin M, Song S H, Kim J M, Kwon C H, Joh J W, Lee S-K, Kim S-J
Department of Surgery, Division of Transplant Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Transplant Proc. 2011 Jul-Aug;43(6):2365-78. doi: 10.1016/j.transproceed.2011.05.032.
Alemtuzumab (Campath-1H), a humanized monoclonal antibody directed against CD52, is a lymphocyte-depleting agent currently being evaluated as an induction agent in solid organ transplantation. This study analyzed the clinical outcomes and effects on peripheral blood lymphocyte subset counts in adult deceased donor renal transplant recipients who received an alemtuzumab-based induction protocol.
Eleven kidney alone or simultaneous pancreas-kidney transplant recipients received 20 mg alemtuzumab on postoperative days 0 and 1, followed by calcineurin inhibitor-based maintenance immunosuppression after postoperative day 5. We collected 1-year data including recipient and donor demographic features, renal function and adverse events including endocrine impact, incidence of acute rejection episodes, infections or malignancies as well as hematologic and late immunologic parameters for correlation with patient or graft survival.
Mean HLA mismatch was 3.6 and 8/11 deceased donors were of the extended criteria type. Only 2 (18%) recipients displayed delayed graft function with a failure of the serum creatinine to decrease by 25% on the first day; however, their long-term outcomes were similar to other nonaffected patients. Serious adverse events were absent; there was no hyperlipidemia or new-onset diabetes. We failed to observe an acute rejection. The 3 (27%) recipients with infectious complications experienced pericardial tuberculosis, urinary tract infection, or invasive pulmonary aspergillosis. Two (18%) cases of posttransplantation lymphoproliferative disease were diagnosed in this study during the follow-up. Overall patient and graft survival rates were both 91%.
This study demonstrated that preconditioning with antibody-depletion using alemtuzumab was efficient with satisfactory patient and graft survivals at 1 year. Alemtuzumab induction was safe even for recipients of extended criteria donor renal transplantation.
阿仑单抗（Campath-1H）是一种针对CD52的人源化单克隆抗体，是一种淋巴细胞清除剂，目前正在作为实体器官移植的诱导剂进行评估。本研究分析了接受基于阿仑单抗的诱导方案的成年死亡供体肾移植受者的临床结局以及对外周血淋巴细胞亚群计数的影响。
11名单纯肾移植或胰肾联合移植受者在术后第0天和第1天接受20mg阿仑单抗，术后第5天开始接受基于钙调神经磷酸酶抑制剂的维持免疫抑制治疗。我们收集了1年的数据，包括受者和供者的人口统计学特征、肾功能以及不良事件，包括内分泌影响、急性排斥反应发作的发生率、感染或恶性肿瘤，以及血液学和晚期免疫学参数，以与患者或移植物存活情况进行相关性分析。
平均HLA错配数为3.6，11名死亡供者中有8名属于扩展标准类型。只有2名（18%）受者出现移植肾功能延迟恢复，血清肌酐在第一天未下降25%；然而，他们的长期结局与其他未受影响的患者相似。未发生严重不良事件；没有高脂血症或新发糖尿病。我们未观察到急性排斥反应。3名（27%）发生感染并发症的受者分别经历了心包结核、尿路感染或侵袭性肺曲霉病。本研究在随访期间诊断出2例（18%）移植后淋巴细胞增殖性疾病。总体患者和移植物存活率均为91%。
本研究表明，使用阿仑单抗进行抗体清除预处理是有效的，患者和移植物1年存活率令人满意。即使对于扩展标准供体肾移植受者，阿仑单抗诱导也是安全的。
