CAMPATH PRECONDITIONING AND TACROLIMUS MONOTHERAPY WITH SUBSEQUENT WEANING IN RENAL TRANSPLANT RECIPIENTS

Abstract

O144 Aims: After elucidating the mechanisms of alloengraftment, we proposed a strategy of tolerogenic immunosuppression that facilitates these mechanisms. Two principles were applied: recipient pretreatment and the minimal use of post-transplant immunosuppression. In an earlier series, kidney recipients were preconditioned with Thymoglobulin and given post-transplant monotherapy with tacrolimus. Methods: Between November 2002 and September 2003, we substituted 30 mg Campath 1-H for Thymoglobulin in 96 adult kidney recipients (mean age 50.3 ± 16.4 years; range 17 - 82). Thirteen (13.5%) were undergoing retransplantation, and 20 (20.8%) had a PRA >20%. Mean HLA mismatches were 3.7 ± 1.6. There were 59 (61.5%) cadaver donors (mean cold ischemia 20.9 ± 7.3 hours) and 37 (38.5%) live donors. Mean donor age was 41.4 ± 15.9 years (range 1 – 72). Post-transplant immunosuppression was with tacrolimus monotherapy (target levels 10 mg/ml), with dose spacing to every other day or longer at various times after about four months. Results: With a mean follow up of 8.7 ± 2.4 months, the patient and graft survival rates are 97% and 95%, respectively, with a mean serum creatinine of 1.5 ± 0.6 mg/dl. Only one patient (1%) in the cohort has had acute rejection (steroid responsive) prior to weaning. Weaning was attempted in 73 (76%) and is ongoing in 69 (72%) patients. Four (5.5%) developed rejection after attempted weaning. Thirty-eight (40%) are on every other day tacrolimus, 30 (31%) are on three times a week tacrolimus, and one (1%) is on every third day tacrolimus. The incidence of delayed graft function was 10.4%. The incidence of CMV disease and diabetes was 0%. One (1%) patient developed PTLD. Conclusions: Although the follow up is still short, we conclude that the use of Campath 1-H for pretreatment has significantly improved the efficacy of our tolerogenic regimen of immunosuppression.