Alemtuzumab induction combined with reduced maintenance immunosuppression is associated with improved outcomes after lung transplantation: A single centre experience.
Adult
Aged
Alemtuzumab
/ therapeutic use
Antilymphocyte Serum
/ therapeutic use
Antineoplastic Agents, Immunological
/ therapeutic use
Creatinine
/ blood
Female
Glomerular Filtration Rate
Graft Survival
/ drug effects
Humans
Immunosuppressive Agents
/ therapeutic use
Induction Chemotherapy
/ methods
Kaplan-Meier Estimate
Lung Transplantation
/ methods
Male
Middle Aged
Outcome Assessment, Health Care
/ methods
Retrospective Studies
Young Adult
Journal
PloS one
ISSN: 1932-6203
Titre abrégé: PLoS One
Pays: United States
ID NLM: 101285081
Informations de publication
Date de publication:
2019
2019
Historique:
received:
02
05
2018
accepted:
21
12
2018
entrez:
16
1
2019
pubmed:
16
1
2019
medline:
19
11
2019
Statut:
epublish
Résumé
The value of induction therapy in lung transplantation is controversial. According to the ISHLT, only about 50% of patients transplanted within the last 10 years received induction therapy. We reviewed our institutional experience to investigate the impact of induction therapy on short- and long-term outcomes. Between 2007 and 2015, 446 patients with a complete follow-up were included in this retrospective analysis. Analysis comprised long-term kidney function, infectious complications, incidence of rejection and overall survival. A total of 231 patients received alemtuzumab, 50 patients antithymocyte globulin (ATG) and 165 patients did not receive induction therapy (NI). The alemtuzumab group revealed the lowest rate of chronic kidney insufficiency (NI: 52.2%; ATG: 60%; alemtuzumab: 36.6%; p = 0.001). Both, the NI group (p<0.001) and the ATG group (p = 0.010) showed a significant increase of serum creatinine during follow-up compared to alemtuzumab patients. Furthermore, alemtuzumab group experienced the lowest rate of infection in the first year after transplantation. Finally, improved survival, low rates of acute cellular rejection (ACR), lymphocytic bronchiolitis (LB) and chronic lung allograft dysfunction (CLAD) were found in patients treated either with alemtuzumab or ATG. Alemtuzumab induction therapy followed by reduced maintenance immunosuppression is associated with a better kidney function compared to no induction and ATG. Survival rate as well as freedom from ACR and CLAD were comparable between alemtuzumab and ATG.
Identifiants
pubmed: 30645645
doi: 10.1371/journal.pone.0210443
pii: PONE-D-18-13224
pmc: PMC6333331
doi:
Substances chimiques
Antilymphocyte Serum
0
Antineoplastic Agents, Immunological
0
Immunosuppressive Agents
0
Alemtuzumab
3A189DH42V
Creatinine
AYI8EX34EU
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0210443Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
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