Alemtuzumab induction combined with reduced maintenance immunosuppression is associated with improved outcomes after lung transplantation: A single centre experience.

Alberto Benazzo,György Lang,Thomas Schweiger,Shahrokh Taghavi,Konrad Hoetzenecker,José Matilla Sigüenza,Walter Klepetko,Gabriela Muraközy,Moritz Muckenhuber,Peter Jaksch,Bernhard Moser,Stefan Schwarz,Cristopher Lambers,Justyna Gołębiewska

doi:10.1371/journal.pone.0210443

Alberto Benazzo, György Lang + Show 12 more

Open Access

https://doi.org/10.1371/journal.pone.0210443

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Journal: PloS one	Publication Date: Jan 15, 2019
Citations: 21	License type: CC BY 4.0

Affiliation: Medical University of Vienna

Abstract

Question addressed by the studyThe value of induction therapy in lung transplantation is controversial. According to the ISHLT, only about 50% of patients transplanted within the last 10 years received induction therapy. We reviewed our institutional experience to investigate the impact of induction therapy on short- and long-term outcomes.Materials/Patients and methodsBetween 2007 and 2015, 446 patients with a complete follow-up were included in this retrospective analysis. Analysis comprised long-term kidney function, infectious complications, incidence of rejection and overall survival.ResultsA total of 231 patients received alemtuzumab, 50 patients antithymocyte globulin (ATG) and 165 patients did not receive induction therapy (NI). The alemtuzumab group revealed the lowest rate of chronic kidney insufficiency (NI: 52.2%; ATG: 60%; alemtuzumab: 36.6%; p = 0.001). Both, the NI group (p<0.001) and the ATG group (p = 0.010) showed a significant increase of serum creatinine during follow-up compared to alemtuzumab patients. Furthermore, alemtuzumab group experienced the lowest rate of infection in the first year after transplantation. Finally, improved survival, low rates of acute cellular rejection (ACR), lymphocytic bronchiolitis (LB) and chronic lung allograft dysfunction (CLAD) were found in patients treated either with alemtuzumab or ATG.ConclusionAlemtuzumab induction therapy followed by reduced maintenance immunosuppression is associated with a better kidney function compared to no induction and ATG. Survival rate as well as freedom from ACR and CLAD were comparable between alemtuzumab and ATG.

Highlights

Lung transplantation remains the only therapeutic option for a variety of end-stage lung diseases, its long-term outcome continues to be poor [1]
The alemtuzumab group revealed the lowest rate of chronic kidney insufficiency (NI: 52.2%; antithymocyte globulin (ATG): 60%; alemtuzumab: 36.6%; p = 0.001)
The not receive induction therapy (NI) group (p

Summary

Introduction

Lung transplantation remains the only therapeutic option for a variety of end-stage lung diseases, its long-term outcome continues to be poor [1]. The rationale behind its use is to prevent acute cellular rejection (ACR) episodes, to delay initiation of maintenance immunosuppression and to reduce of its cumulative dose. The majority of lung transplant centres use IL2R Antagonists (IL2RA) reporting varying outcomes after lung transplantation [5,6,7,8,9,10,11,12]. Polyclonal anti-lymphocyte preparations (ATG) are the second most used induction agents. They can effectively reduce ACR rates they are associated with adverse effects such as thrombocytopenia, leukopenia and anemia

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