L/I‐4 Living donor liver transplants with alemtuzumab induction and steroid‐free tacrolimus monotherapy

Abstract

Introduction: Alemtuzumab (Campath‐1H) is a humanized anti‐CD52 monoclonal antibody that results in prolonged depletion of T and other immune cells.Patients and methods: Alemtuzumab (30 mg IV x1) was used for induction in 45 consecutive right lobe adult‐to‐adult living donor liver transplants (RLALDLTs) from 6/10/03 to 9/20/05 at the Starzl Transplantation Institute. Maintenance immunosuppression was with steroid‐free tacrolimus monotherapy, which was weaned when possible. The mean preoperative MELD score was 12.4 (6 to 25); mean follow‐up was 18.6 + 8.6 months.Results: Our 1‐year recipient and graft survival rates were 93.3% and 91.1%, and compare well to UNOS data (89.1%, 79.3%). The cumulative acute cellular rejection (ACR) incidence was 0% at 1 mos, 2.4% at 2 mos, 4.8% at 3 mos, 7.3% at 4 mos, 8.9% at 12 mos, and 11.1% at 18 mos. Preweaning ACR was 8.9% (n=4) and only 1 patient had post‐weaning ACR. Weaning was attempted in 38% (n=17) of recipients. At follow‐up, of the 39 living patients, 19 are maintained on daily tacrolimus monotherapy, 7 on qod tacrolimus monotherapy, and 7 on 3x/week tacrolimus monotherapy. The 18.6‐mos recipient and graft survival rates were 88.9% and 86.7%. The mean total bilirubin of our survivors is 0.83 (+ 0.51). There were minimal infectious complications, with no incidence of tissue‐invasive CMV disease, no PTLD, and no posttransplant insulin‐dependent diabetes.Discussion: This study represents the largest series to date of RLALDLT recipients undergoing alemtuzumab induction and steroid‐free tacrolimus monotherapy, and confirms the short‐term safety and efficacy of this approach.