From the Guidelines
Alemtuzumab (Allosure) is commonly used in simultaneous kidney-pancreas transplantation (SPK) as induction immunosuppression therapy, with a typical regimen involving a single dose of 30mg administered intravenously during the transplant procedure. The use of alemtuzumab in SPK transplantation has been associated with reduced rates of acute rejection while allowing for lower doses of maintenance immunosuppressants, potentially decreasing long-term toxicity 1. Following alemtuzumab induction, patients typically transition to maintenance immunosuppression with tacrolimus, mycophenolate mofetil, and sometimes low-dose steroids. Important considerations include premedication with acetaminophen, diphenhydramine, and methylprednisolone to prevent infusion reactions, and prophylaxis against opportunistic infections (particularly cytomegalovirus, Pneumocystis jirovecii pneumonia, and fungal infections) due to the profound immunosuppression 1. Patients should be monitored for potential side effects including cytopenia, increased infection risk, and autoimmune disorders. The benefits of pancreas transplantation in improving the quality of life of patients with difficult-to-control diabetes are well-established, and it is recommended for patients with type 1 diabetes who have undergone or plan to undergo kidney transplantation 1. However, the decision to use alemtuzumab in SPK transplantation should be made on a case-by-case basis, taking into account the individual patient's risk factors and medical history. Key points to consider when using alemtuzumab in SPK transplantation include:
- Monitoring for potential side effects, including cytopenia and increased infection risk
- Premedication with acetaminophen, diphenhydramine, and methylprednisolone to prevent infusion reactions
- Prophylaxis against opportunistic infections
- Transition to maintenance immunosuppression with tacrolimus, mycophenolate mofetil, and sometimes low-dose steroids.
From the Research
Data on Allosure Use in Simultaneous Kidney Pancreas Transplant
- The provided studies do not directly mention the term "allosure" in the context of simultaneous kidney pancreas transplant.
- However, the studies discuss various immunosuppressive regimens used in simultaneous pancreas-kidney transplantation, including the use of tacrolimus, sirolimus, mycophenolate mofetil (MMF), and azathioprine 2, 3, 4, 5, 6.
- According to the study by 6, a randomized trial compared tacrolimus- and sirolimus-based immunosuppression after simultaneous pancreas and kidney transplantation, with 5-year results showing no difference in renal and pancreas graft survival between the two groups.
- Another study by 3 found that MMF treatment significantly decreases the incidence of biopsy-proven acute rejection in SPK transplant recipients compared with AZA-treated historical controls.
- The study by 4 demonstrated that MMF is a highly effective immunosuppressant in SPK transplantation, reducing the frequency of acute cellular and steroid-resistant rejection, and resulting in significantly improved graft survival rates.
- The use of induction therapy with either alemtuzumab or rabbit antithymocyte globulin (rATG) in combination with a calcineurin inhibitor (CNI) and MMF or sirolimus appears to be safe and effective in the setting of rapid steroid withdrawal (RSW) 2.