Abstract | BACKGROUND: The optimal immunosuppressive regimen in simultaneous pancreas-kidney transplant (SPKT) recipients that prevents acute rejection episodes (AREs) and allows optimal outcome remains elusive. METHODS: RESULTS: Overall number of AREs at 3 years was significantly lower with alemtuzumab versus ATG induction (26.0% vs 43.5%; adjusted hazard ratio, 0.38; P = 0.029). Most AREs (94.6%) with ATG occurred within the first month, whereas 84.2% of AREs with alemtuzumab occurred beyond 3 months. Patients with and without an ARE in the steroid-free alemtuzumab group showed no differences in composition of lymphocytes, or in alemtuzumab levels. Of note, more than two thirds of these AREs were preceded by empiric tacrolimus and/or mycophenolate mofetil dose adjustments due to viral infections, leukopenia, or gastrointestinal symptoms. CONCLUSIONS:
Alemtuzumab induction resulted in a significant lower incidence of AREs. Empiric dose adjustments beyond 3 months in the absence of steroids carry a significant risk for subsequent rejection in SPKT recipients.
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Authors | Jonna R Bank, Sebastiaan Heidt, Dirk Jan A R Moes, Dave L Roelen, Marko J K Mallat, Paul J M van der Boog, Manon Vergunst, Cornelia M Jol-van der Zijde, Robbert G M Bredius, Andries E Braat, Jan Ringers, Maarten J D van Tol, Frans H J Claas, Marlies E J Reinders, Johannes W de Fijter |
Journal | Transplantation direct
(Transplant Direct)
Vol. 3
Issue 1
Pg. e124
(Jan 2017)
ISSN: 2373-8731 [Print] United States |
PMID | 28349124
(Publication Type: Journal Article)
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