Alemtuzumab as Second-Line Treatment for Late Antibody-Mediated Rejection of Transplanted Kidneys

Whether the anti-CD52 monoclonal antibody alemtuzumab can be an effective treatment option for late antibody-mediated rejection (ABMR) is not known. In a single-center pilot study, 12 patients with ABMR were given 30 mg subcutaneous alemtuzumab.Median time from transplantation to biopsy was 22 months 10 of recipients fulfilling criteria histologic diagnosis chronic-active ABMR. The estimated glomerular filtration rate (eGFR) loss before 1.2 mL/min/mo graft (eGFR <15 mL/min) expected occur within 2 years in 11 cases. All showed no or inadequate response initial steroids and intravenous immunoglobulin. eGFR at administration 35 mL/min/1.73 m (IQR, 30-42) stabilized improved months. Proteinuria stable year after alemtuzumab. At 3-year follow-up, death-censored survival 68% (uncensored 58%). Five cases that could evaluated follow-up had (on average 44 mL/min 42 36 months). Alemtuzumab generally well tolerated only opportunistic infections noted. One case symptomatic parvovirus B infection 1 BK viral occurred, which both cleared follow-up. conclusion, may value as second-line rapid eGFR.