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Title: Induction With Rituximab and Alemtuzumab Effectively Desensitises Recipients of Living Donor Kidneys: Presented at ATC
URL: http://www.pslgroup.com/dg/222E52.htm
Doctor's Guide
June 3, 2008

By Thomas S. May

TORONTO -- June 3, 2008 -- A novel method of desensitising living donor kidney transplant recipients that uses rituximab and alemtuzumab induction therapy is highly effective and well tolerated, according to a study presented here at the 2008 American Transplant Congress (ATC).

The strategy integrates therapies to disrupt memory-dependent antibody responses by purging both T-helper and B cells with the help of alemtuzumab and rituximab.

John J. Friedewald, MD, Northwestern University Feinberg School of Medicine, Chicago, Illinois, and colleagues enrolled 21 patients with donor-specific antibodies (DSA) and 7 patients with ABO incompatibility.

In the study, patients were given a single 375-mg dose of rituximab 2 to 4 weeks before transplantation and received plasmapheresis and IV immunoglobulin 0.2 gm/kg until at least an 8-fold reduction was observed in DSA, anti-A, or anti-B titres. They were also given alemtuzumab induction 30 mg IV intraoperatively. Immunosuppression was maintained using tacrolimus, mycophenolate mofetil, and steroids tapered for 6 months.

Median follow-up for patients with DSA was 3 years, and 6 months for patients with ABO incompatibility.

Three patients developed serious complications during the follow-up period, and overall survival was 100%.

Based on these results, the researchers concluded that a combination of rituximab, plasmapheresis, and IV immunoglobulin, with alemtuzumab induction and triple immunosuppression maintenance is a well tolerated, highly effective, and durable means of antibody desensitisation in renal transplant patients.
"This work is significant because it may help patients get transplanted who previously had little chance of a successful transplant," Dr. Friedewald said during his poster session on May 31.

"We used a different combination of medications, compared to other protocols, and our approach has yielded excellent outcomes for these patients," he added.


[Presentation title: Desensitization of Living Donor Renal Transplant Recipients Using Rituximab and Alemtuzumab Induction Therapy. Abstract 656]

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