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Islet and Pancreas Overlap

Friday October 22, 2021 - 16:00 to 17:20

Room: Virtual Room 1

306.8 Impact of Alemtuzumab Induction on Pancreas Transplant Outcomes

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Joseph R. Scalea, United States

Associate Professor of Surgery
Department of Surgery
University of Maryland, School of Medicine

Biography

Dr. Scalea was named a “Top Doctor” in the specialty of Transplant: Kidney/Pancreas/Liver by Baltimore magazine in 2020. Dr. Scalea is a multi-organ transplant surgeon and the director of pancreas and islet cell transplantation at the University of Maryland. Dr. Scalea completed surgical training at the University of Maryland. He spent two years studying transplantation biology at Harvard Medical School under the mentorship of David H. Sachs. Dr. Scalea then did a transplant fellowship at the University of Wisconsin immediately prior to joining the faculty at the University of Maryland. At the University of Maryland, Dr. Scalea focuses on pancreas transplantation as well as autologous and allogeneic islet cell transplantation. He also works clinically on both the kidney and liver transplant teams. In addition to clinical work, Dr. Scalea directs a translational immunology laboratory focused on novel methods for inducing transplantation tolerance. Dr. Scalea has published more than 40 peer-reviewed publications in addition to multiple book chapters and published abstracts. Beyond basic science, Dr. Scalea has published on the topic of transplantation ethics in both the Atlantic and Readers' Digest. He previously received research grant support from the NIH and the American Society of Transplantation. Dr. Scalea is currently funded by the Greenwall Foundation to study innovations in organ donation as well as the American Surgical Association Foundation to study novel methods of transplantation tolerance induction. Dr. Scalea is also a painter and a musician. Works of his are currently on display in Baltimore and in Washington, DC.

Abstract

Impact of Alemtuzumab Induction on Pancreas Transplant Outcomes

Abdolreza Haririan1, Ian Booth2, Brian Masters2, Jillian Casale2, Joseph Scalea3, Cinthia Drachenberg4.

1Medicine, University of Maryland, Baltimore, MD, United States; 2Pharmacy, University of Maryland Medical Center, Baltimore, MD, United States; 3Surgery, University of Maryland, Baltimore, MD, United States; 4Pathology, University of Maryland, Baltimore, MD, United States

The impact of the current choices of induction therapy for pancreas transplantation (PT), particular alemtuzumab, on transplant outcomes have not been well studied. 

We conducted a single center, retrospective cohort study comparing pancreas transplant outcomes including patinet survival, pancreas allograft survival, and biopsy-proven acute rejection in both solitary and combined PT recipients receiving basiliximab, rATG, or alemtuzumab induction.

A total of 428 PTs transplanted between January 2000 and May 2018 were included in the final analysis (48 in basiliximab group, 199 in rATG group and 181 in alemtuzumab group).  The overall patient survival rate was significantly higher in the alemtuzumab group compared to the rATG group (adjusted HR 0.45, 95%CI 0.22-0.94, P=0.033), while basiliximab was comparable to rATG (HR 0.89, 95% CI 0.43-1.82; p=0.74) [Figure 1]. Death-censored pancreas graft loss was similar between the groups (HR 0.7, 95% CI 0.79-2.86; p=0.11 for alemtuzumab, and HR 1.08, 95% CI 0.62-1.87; p=0.8 for basiliximab) [Figure 2]. Incidence of BPAR was similar between the groups (HR 0.82, 95% CI 0.38-1.77; p=0.61 for alemtuzumab, and HR 0.61, 95% CI 0.36-1.04; p=0.07 for basiliximab). However, more severe rejection was observed more frequently in rATG group (41.7% versus 23.8% in alemtuzumab, and none in basiliximab groups).  The observed infectious complications were comparable between the induction groups.

Our study suggests that alemtuzumab is a safe and effective induction agent that can be utilized for PT recipients to achieve outcomes comparable to other available agents, with a possible survival advantage for the patients.


Presentations by Joseph R. Scalea