Peddi VR, Hariharan S, Schroeder TJ, et al. 12 months posttransplant and WBC counts were significantly lower for 3 years after transplant compared with pretransplant level. Cytomegalovirus contamination and bacterial infection occurred in 28% and 36% of patients, respectively. Eleven percent of patients developed donor-specific antibodies and 7% of patients experienced antibody-mediated rejection. Conclusion A single dose of 30 mg alemtuzumab induction with steroid-free maintenance immunosuppression achieved excellent mid-term patient and graft survival RG14620 for pancreas transplantation with acceptable complication rate. Keywords: Pancreas transplant, Alemtuzumab, Graft survival Alemtuzumab is usually a humanized anti-CD52 monoclonal antibody that is aimed for treatment of chronic lymphocytic leukemia and has now been increasingly used in organ transplantation (1). CD52 is usually a glycoprotein expressed on approximately 95% of peripheral blood lymphocytes, natural killer cells, monocytes, macrophages, and thymocytes; therefore, almost all mononuclear cells are affected (2). There does not seem to be any effect on plasma cells and similar to other induction brokers, alemtuzumab seems to spare memory type cells (3). After binding to its target, alemtuzumab causes cell death through several mechanisms including complement-mediated cytolysis, antibody-mediated cytotoxicity, and apoptosis. Although the plasma elimination half-life of alemtuzumab is usually approximately 12 days, its clinical effects are far more persistent (1, 4). Lymphocyte depletion of more than 99% can be seen after a single dose with varying rates of cellular recovery depending on the subpopulation of interest (5). The first reports of renal transplantation recipients treated with alemtuzumab induction with low dose cyclosporine monotherapy were described by Calne et al. (6, 7). Subsequently, alemtuzumab has increased in popularity as an induction immunosuppression for organ transplantation (1, 8C11). Alemtuzumab induction has demonstrated its ability of low-dose maintenance immunosuppression without steroid with acceptable risk of early rejection or calcineurin inhibitor and steroid free (12, 13). The majority of the clinical RG14620 experience with alemtuzumab has been primarily with renal transplantation, and the experience of alemtuzumab induction for pancreas transplantation is JIP2 still limited. In this report, we describe our experience with a single dose of 30 mg alemtuzumab induction with steroid-free maintenance immunosuppression in RG14620 pancreas transplantation. RESULTS Patient and Graft Survival One-year actuarial patient/pancreas graft survival was 100%/100% in simultaneous kidney-pancreas transplantation (SPK), pancreas after kidney transplantation (PAK), and pancreas transplant alone (PTA). Three-year actuarial patient/pancreas graft survival rates of SPK, PAK, and PTA were 100%/100%, 100%/100%, and 100%/83%, respectively. One- and 3-12 months kidney graft survival rates were 100% and 100%, respectively. Only one patient lost pancreas graft due to posttransplant insulin resistance (C-peptide level 5.3 ng/mL). Graft Function Physique 1(A) shows that the glucose levels were well maintained during the study period. One and 3 years posttransplant, C-peptide level was 2.61.4 ng/mL and 3.51.2 ng/mL, respectively. Physique 1(B) shows that posttransplant hemoglobin A1C levels also were maintained below 6% during the study period. Physique 1(C) shows that serum creatinine levels in SPK patients were stable during the study period. Creatinine levels at 1 and 3 years posttransplant were 1.510.77 mg/dL and 1.220.33 mg/dL, respectively. Open in a separate window Physique 1 (A) Mean random glucose level posttransplant. (B) Mean hemoglobin A1C level posttransplant. (C) Mean creatinine level posttransplant. (D) Mean absolute lymphocyte counts level posttransplant *> 0.0003)No differenceNo difference6 moKaufman et???al. (10)Retrospective???review with???historical???controlSPK50Tac, sirolimusYesAlemtuzumab vs.???Thymoglobulin30 mg1 vs. 1 mg/???kg6Patient survivalKidney graft survivalPancreas graft???survivalRejectionViral infection91% vs. 92% at 3 yr91% vs. 86% at 3 yr92% vs. 97% RG14620 at 3 yr8% vs. 5% in 2 yr10% vs. 40% in 3 yr22C41 moThai et al.???(38)Retrospective???reviewSPK/PAK/PTA60TacYesAlemtuzumab vs.???none30 mg1 vs. nonePatient survivalKidney graft survivalPancreas graft???survivalRejectionCMV infection95% at 1 yr90% at 1 yr93% at.