Campath-1H induction therapy in African American and hispanic first renal transplant recipients: 3-year actuarial follow-up

Gaetano Ciancio, George W. Burke, Jeffrey J. Gaynor, Junichiro Sageshima, Eva Herrada, Lissett Tueros, David Roth, Warren Kupin, Anne Rosen, Violet Esquenazi, Joshua Miller

Research output: Contribution to journalArticle

10 Scopus citations

Abstract

Background. In a retrospective study of the first 75 primary renal transplant patients given alemtuzumab induction at our center, 20 were African American (27%), 32 were Hispanic (43%), and 23 were non-African American, non- Hispanic (31%). Methods. Alemtuzumab was given intraoperatively and 4 days later (0.3 mg/kg), with planned low-dose maintenance mycophenolate mofetil (500 mg twice daily) and tacrolimus (targeted trough levels of 5 to 7 ng/ml) and no corticosteroid therapy after the first week. Median follow-up among ongoing survivors with a functioning graft was 45 months. Results. Three-year actuarial patient and graft survival rates were 95% and 85% in African Americans, 89% and 78% in Hispanics, and 96% and 96% in non-African Americans, non-Hispanics, respectively (not significant). Bioavailability of tacrolimus was significantly lower among African Americans in comparison with the other patient subgroups (P≤.002). While the incidence of biopsy-proven acute rejection was 20% (4/20) in African Americans, 19% (6/32) in Hispanics, and 13% (3/23) in non-African American, non-Hispanic (not significant), chronic allograft dysfunction occurred more frequently among African Americans (10/20) in comparison with Hispanics (8/32) and non-African American, non-Hispanics (8/23) (P=0.08, log-rank test). In addition, there was a trend at 6 and 12 months posttransplant for the mean serum creatinine to be less favorable among African American patients (P=0.08 and 0.07). No group had increased infection or malignancy. Conclusions. This immunosuppressive protocol appears reasonably safe for 3 years after renal transplantation but suggests higher incidences of biopsy-proven acute rejection, chronic allograft dysfunction, and borderline poorer renal function among African Americans in comparison with the other patient subgroups.

Original languageEnglish (US)
Pages (from-to)507-516
Number of pages10
JournalTransplantation
Volume85
Issue number4
DOIs
StatePublished - Dec 1 2008
Externally publishedYes

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Keywords

  • African-Americans
  • Hispanics
  • Induction therapy
  • Kidney transplantation
  • Mycophenolate mofetil
  • Racial minorities
  • Steroid avoidance
  • Tacrolimus

ASJC Scopus subject areas

  • Transplantation
  • Immunology

Cite this

Ciancio, G., Burke, G. W., Gaynor, J. J., Sageshima, J., Herrada, E., Tueros, L., Roth, D., Kupin, W., Rosen, A., Esquenazi, V., & Miller, J. (2008). Campath-1H induction therapy in African American and hispanic first renal transplant recipients: 3-year actuarial follow-up. Transplantation, 85(4), 507-516. https://doi.org/10.1097/TP.0b013e318163619f