Z LI 1,2, M HEER 1, P TREVILLIAN 1, T MYINT 1
1John Hunter Hospital Hunter New England Health, New Lambton, Australia, 2University of Newcastle , Callaghan, Australia
Introduction: Acute rejection of kidney allograft often requires an aggressive immunosuppressive therapy to salvage graft function. Alemtuzumab (anti-CD52 antibody) has been used for refractory rejections in solid organ transplant recipients. We present a case series using Alemtuzumab as rescue therapy in kidney transplant recipients at our transplant unit in regional New South Wales, Australia.
Methods: Patients who received Alemtuzumab therapy in last 10 years at our unit were reviewed. We retrospectively examined their graft outcome as creatinine and estimated GFR at regular intervals for 12 months following Alemtuzumab therapy. We also examined the adverse outcomes associated with Alemtuzumab during the same period.
Result: Four patients received Alemtuzumab therapy. All of them had steroid resistant rejection (three at least Type IB acute cellular and one vascular rejection) identified at repeated allograft biopsies prior to Alemtuzumab. Three patients had already received steroids, anti-thymoglobulin and plasmapheresis, while one patient had received only steroids due to neutropenia. Alemtuzumab was given as a rescue therapy. Two patients showed graft function improvement with resolution of rejection and no significant infection was reported. However, two other patients did not show any improvement in creatinine and experienced recurrent infections on follow-up. One of them had life threatening multi-organisms opportunistic infections, which was successfully treated. There was no mortality or need to resume maintenance dialysis at 12-month follow up in all four patients.
Discussion: Our experience showed that using Alemtuzumab after multiple lines of anti-rejection therapies achieved short-term graft function stability but at the cost of potentially serious opportunistic infections. This review highlights the need to balance the potential risk and benefit in using Alemtuzuamb and importance of patients’ engagement in decision-making.
BMed, MD, PgCert Med
Second year Advanced Trainee of Nephrology with special interest in renal transplantation