Campath-1H Induction in Adult Liver Transplantation: Long-Term Follow Up of 300 Patients

Abstract

Introduction: The present study provides the long term follow up of our adult liver transplant recipients induced with alemtuzumab (Campath 1H, C1H). Methods: This is a retrospective analysis of patients who underwent liver transplantation using C1H induction at our Center from 2001 until 2010. C1H was not administered to patients with Hepatitis C (HCV). Maintenance immunosuppression was with half the usual dose of tacrolimus. Patients receiving steroids for their underlying (autoimmune) disease were maintained on the same dose after transplantation. No other steroids were given except for acute rejection episodes. Patients transplanted before April 2004 received four doses of C1H starting pre-operatively, whereas those transplanted afterwards received two or a single dose of C1H starting immediately after the transplant. Results: Three hundred and four patients (192 male, 112 female), received a liver allograft with C1H induction immunosuppression, Seventy three patients received 4 doses of C1H, the first one pre-operatively, 231 patients received two (n=77) or one (n=154) dose, starting immediately post-operatively. One, three, five and seven year patient survival was 91.4%, 87.35%, 84.62% and 82.83%. One, three, five and seven year graft survival was 89.47%, 84.69%, 80.84% and 78.36%. One, three, five and seven year freedom from rejection was 57.79%, 52.32%, 47.43%, 46.02%. There was no significant difference in incidence of rejection between patients that received the first dose of Campath-1H before or after the transplant. Average tacrolimus trough levels were between 5-7 ng/ml for the first 2 years post transplantation and less than 5 ng/ml thereafter. Twelve patients have required long term renal replacement therapy to date, five requiring kidney transplantation and seven additional patients dialysis. One, three, five and seven year freedom from renal replacement was 99.64%, 98.89%, 96.03%, 92.77%. Seven patients were weaned off immunosuppression 3-7 years post-transplantation. Conclusion: C1H induction with low dose tacrolimus maintenance immunosuppression leads to good outcomes in non-HCV liver transplant recipients. Postoperative administration of C1H is as effective as preoperative exposure.