Induction therapy with alemtuzumab, followed by lower than conventional intensity posttransplant immunosuppression (e.g., tacrolimus monotherapy), has been associated with reduced morbidity and mortality in abdominal and heart transplantation. We examined 5-year outcomes in lung recipients receiving alemtuzumab in conjunction with reduced intensity posttransplant immunosuppression (early lower dose tacrolimus; lower dose steroids, with or without mycophenolate mofetil), compared to lung recipients receiving other induction agents or no induction in association with posttransplant immunosuppression.
A retrospective analysis was performed utilizing prospectively collected data from a single-site clinical database on 336 lung recipients (aged≥18) transplanted between 1998 and 2005, classified by induction type: alemtuzumab (n=127), Thymoglobulin (n=43), daclizumab (n=73), none (n=93). Survival analyses examined patient and graft survival, and freedom from acute cellular rejection (ACR), lymphocytic bronchiolitis, obliterative bronchiolitis (OB), bronchiolitis obliterans syndrome (BOS), and post-transplant lymphoproliferative disorder (PTLD).
Five-year patient and graft survival differed by group (p=.046, p=.038, respectively). Alemtuzumab patient/graft survival rates were 59%/59%. Survival rates were 60%/44% for Thymoglobulin, 47%/46% for no-induction, and 44%/41% for daclizumab. Freedom from ACR, lymphocytic bronchiolitis, OB, and BOS differed by group (all p’s<.008); alemtuzumab recipients showed greater 5-year freedom from each outcome (30%/82%/86%/54%) than Thymoglobulin (20%/54%/62%/27%), daclizumab (19%/55%/70%/43%) and no-induction groups (18%/68%/69%/46%). The groups did not differ in PTLD rates (p=.864, ≥94% free of PTLD at 5 years). Effects were unchanged after controlling for potential covariates.
Alemtuzumab induction may be associated with improved outcomes in lung transplantation. Randomized controlled trials are needed to establish any effects of this agent.