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. 2012 Apr 24;2(2):19-26.
doi: 10.5500/wjt.v2.i2.19.

Antibody induction therapy in adult kidney transplantation: A controversy continues

Kanwaljit K Chouhan  1 , Rubin Zhang
Affiliations

Antibody induction therapy in adult kidney transplantation: A controversy continues

Kanwaljit K Chouhan et al. World J Transplant. .

Abstract

Antibody induction therapy is frequently used as an adjunct to the maintenance immunosuppression in adult kidney transplant recipients. Published data support antibody induction in patients with immunologic risk to reduce the incidence of acute rejection (AR) and graft loss from rejection. However, the choice of antibody remains controversial as the clinical studies were carried out on patients of different immunologic risk and in the context of varying maintenance regimens. Antibody selection should be guided by a comprehensive assessment of immunologic risk, patient comorbidities, financial burden as well as the maintenance immunosuppressives. Lymphocyte-depleting antibody (thymoglobulin, ATGAM or alemtuzumab) is usually recommended for those with high risk of rejection, although it increases the risk of infection and malignancy. For low risk patients, interleukin-2 receptor antibody (basiliximab or daclizumab) reduces the incidence of AR without much adverse effects, making its balance favorable in most patients. It should also be used in the high risk patients with other medical comorbidities that preclude usage of lymphocyte-depleting antibody safely. There are many patients with very low risk, who may be induced with intravenous steroids without any antibody, as long as combined potent immunosuppressives are kept as maintenance. In these patients, benefits with antibody induction may be too small to outweigh its adverse effects and financial cost. Rituximab can be used in desensitization protocols for ABO and/or HLA incompatible transplants. There are emerging data suggesting that alemtuzumab induction be more successful than other antibody for promoting less intensive maintenance protocols, such as steroid withdrawal, tacrolimus monotherapy or lower doses of tacrolimus and mycophenolic acid. However, the long-term efficacy and safety of these unconventional strategies remains unknown.

Keywords: Acute rejection; Alemtuzumab; Basiliximab; Graft survival; Induction; Kidney transplant; Thymoglobulin.

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References

    1. US Department of Health and Human Services. OPTN/SRTR Annual Report. 2009. Available from: http://www.ustransplant.org/annual_reports/current/506a_ki.htm.
    1. Kirk AD. Induction immunosuppression. Transplantation. 2006;82:593–602. - PubMed
    1. Hardinger KL, Koch MJ, Brennan DC. Current and future immunosuppressive strategies in renal transplantation. Pharmacotherapy. 2004;24:1159–1176. - PubMed
    1. First MR, Schroeder TJ, Hariharan S. OKT3-induced cytokine-release syndrome: renal effects (cytokine nephropathy) Transplant Proc. 1993;25:25–26. - PubMed
    1. Hibberd PL, Tolkoff-Rubin NE, Cosimi AB, Schooley RT, Isaacson D, Doran M, Delvecchio A, Delmonico FL, Auchincloss H, Rubin RH. Symptomatic cytomegalovirus disease in the cytomegalovirus antibody seropositive renal transplant recipient treated with OKT3. Transplantation. 1992;53:68–72. - PubMed