Pascual J et al. (2007) Alemtuzumab induction and recurrence of glomerular disease after kidney transplantation. Transplantation 83: 1429–1434

Thomas PG et al. (2007) Alemtuzumab (Campath 1H) induction with tacrolimus monotherapy is safe for high immunological risk renal transplantation. Transplantation 83: 1509–1512

Two recent Transplantation papers have investigated use of alemtuzumab (Campath®; Genzyme Corporation, Cambridge, MA) as an induction agent in recipients of renal allografts.

Pascual et al. retrospectively investigated whether alemtuzumab induction increased rates of glomerular disease recurrence. They included 443 kidney transplant recipients who had experienced glomerulopathies before transplantation; 161 patients received induction therapy with alemtuzumab, 217 with an interleukin 2 receptor antagonist, and 65 with an antithymocyte antibody. Risk of glomerular disease recurrence was similar in patients receiving alemtuzumab and those receiving interleukin 2 receptor antagonists, and was slightly lower in patients receiving an antithymocyte antibody. Graft and patient survival were similar in all groups.

In an open-label trial, Thomas et al. prospectively investigated use of a tolerogenic induction protocol of alemtuzumab in kidney transplant patients at high risk of rejection (defined as those with panel reactive antibody >20% or previous failed renal transplant). Patients were randomized to either standard antithymocyte antibody induction followed by triple-drug maintenance therapy (controls; n = 8) or tolerogenic induction with single-dose alemtuzumab followed by maintenance tacrolimus monotherapy (n = 11). At 1 year, just one (control) patient had died, and graft survival was similar in the control and alemtuzumab groups (87.5% vs 85.7%). Mean serum creatinine levels in patients with surviving allografts were similar in the groups over the course of 12 months, as were rejection and infection rates.