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Use of alemtuzumab and tacrolimus monotherapy for cadaveric liver transplantation: With particular reference to hepatitis C virus

Marcos, A and Eghtesad, B and Fung, JJ and Fontes, P and Patel, K and DeVera, M and Marsh, W and Gayowski, T and Demetris, AJ and Gray, EA and Flynn, B and Zeevi, A and Murase, N and Starzl, TE (2004) Use of alemtuzumab and tacrolimus monotherapy for cadaveric liver transplantation: With particular reference to hepatitis C virus. Transplantation, 78 (7). 966 - 971. ISSN 0041-1337

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Abstract

We have proposed that the mechanisms of alloengraftment and variable acquired tolerance can be facilitated by minimum posttransplant immunosuppression. It was further suggested that the efficacy of minimalistic treatment could be enhanced by preoperative recipient conditioning with an antilymphoid antibody preparation. A total of 76 adults (38 hepatitis C virus [HCV]-, 38 HCV+ were infused with 30 mg alemtuzumab before primary cadaveric liver transplantation and maintained afterward on daily monotherapy unless breakthrough rejection mandated additional agents. In stable patients, the intervals between tacrolimus doses were lengthened ("spaced weaning") after approximately 4 months. Eighty-four contemporaneous nonlymphoid-depleted liver recipients (58 HCV-, 26 HCV+) were treated with conventional postoperative immunosuppression. The overall incidence of rejection was similar with the two strategies of immunosuppression. With follow-ups of 14 to 22 months, patient and primary graft survival in HCV- cases are 97% and 90%, respectively, with alemtuzumab depletion plus minimal immunosuppression versus 71% and 70%, respectively, under conventional immunosuppression. In HCV+ recipients, current patient and graft survival in the alemtuzumab-pretreated group are 71% and 70% versus 65% and 54%, respectively, under conventional treatment. With both strategies of immunosuppression, the adverse effect of preexisting HCV on survival parameters and graft function already was significant at the 1-year milestone, but its extent was not evident until the second year. With or without HCV, 62% of the 64 surviving lymphoid-depleted patients are on spaced immunosuppression, and four patients receive no immunosuppression. Lymphoid depletion with alemtuzumab and minimalistic maintenance immunosuppression is a practical strategy of liver transplantation in HCV- recipients but not HCV+ recipients.

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Details

Item Type: Article
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Marcos, A
Eghtesad, B
Fung, JJ
Fontes, P
Patel, K
DeVera, M
Marsh, W
Gayowski, T
Demetris, AJ
Gray, EA
Flynn, B
Zeevi, A
Murase, N
Starzl, TEtes11@pitt.eduTES11
Centers: Other Centers, Institutes, Offices, or Units > Thomas E. Starzl Transplantation Institute
Date: 15 October 2004
Date Type: Publication
Journal or Publication Title: Transplantation
Volume: 78
Number: 7
Page Range: 966 - 971
DOI or Unique Handle: 10.1097/01.tp.0000142674.78268.01
Institution: University of Pittsburgh
Refereed: Yes
ISSN: 0041-1337
Other ID: uls-drl:31735062121102, Starzl CV No. 2203
Date Deposited: 08 Apr 2010 17:37
Last Modified: 22 Jun 2021 14:56
URI: http://d-scholarship.pitt.edu/id/eprint/5589

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