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Question Addressed by the Study: The value of induction therapy in lung transplantation is controversial. According to the ISHLT, only about 50% of patients transplanted within the last 10 years received induction therapy. We reviewed our institutional experience to investigate the impact of induction therapy on short- and long-term outcomes., Materials/patients and Methods: Between 2007 and 2015, 446 patients with a complete follow-up were included in this retrospective analysis. Analysis comprised long-term kidney function, infectious complications, incidence of rejection and overall survival., Results: A total of 231 patients received alemtuzumab, 50 patients antithymocyte globulin (ATG) and 165 patients did not receive induction therapy (NI). The alemtuzumab group revealed the lowest rate of chronic kidney insufficiency (NI: 52.2%; ATG: 60%; alemtuzumab: 36.6%; p = 0.001). Both, the NI group (p<0.001) and the ATG group (p = 0.010) showed a significant increase of serum creatinine during follow-up compared to alemtuzumab patients. Furthermore, alemtuzumab group experienced the lowest rate of infection in the first year after transplantation. Finally, improved survival, low rates of acute cellular rejection (ACR), lymphocytic bronchiolitis (LB) and chronic lung allograft dysfunction (CLAD) were found in patients treated either with alemtuzumab or ATG., Conclusion: Alemtuzumab induction therapy followed by reduced maintenance immunosuppression is associated with a better kidney function compared to no induction and ATG. Survival rate as well as freedom from ACR and CLAD were comparable between alemtuzumab and ATG., Competing Interests: The authors have declared that no competing interests exist.

Purpose Within the last years increasing attention has been given to antibody-mediated rejection (AMR) due to its poor long-term outcomes. The impact of alemtuzumab on donor-specific antibodies (DSAs) and AMR in lung transplantation is currently unclear and most evidence comes from kidney transplantation. This study aimed to analyze the impact of alemtuzumab induction on the incidence of DSAs and AMR. Methods All patients transplanted between 2007 and 2017, who received alemtuzumab as induction therapy, were included in this retrospective single-center analysis. The following parameters were evaluated: donor-specific antibodies, C4d deposition, lung histology and occurrence of antibody-mediated rejection. Results Within the study period 525 patients received alemtuzumab as induction therapy. Pre-transplant DSAs were present in 64 (12.2%) recipients (53 anti-HLA class I and 40 anti-HLA class II). De novo (dn) DSAs developed in 93 (17.7%) recipients after transplantation (78 anti-HLA class I and 113 anti-HLA class II). Median time to development of dnDSA was 104 days (42-165) and incidence rates at 1 and 5-years after transplantation were 12.1% and 21.4%, respectively. In 20 (3.8%) recipients clinical AMR was diagnosed. Among them, 7 (35%) patients had a definite diagnosis, 9 (45%) a probable one and 4 (20%) a possible one as defined by the latest ISHLT AMR grading system. Deposition of C4d was only positive in 4 (20%) clinical AMR patients. Capillaritis was observed in 4 (20%) cases and neutrophilic septal margination in 3 cases (15%). Anti-HLA class I and class II were positive in 11 (55%) and 13 (65%) recipients, respectively. Long-term survival of recipients, who developed AMR, was significantly worse than other recipients, with a 5-years rate of 45% vs 75% (p<0.001) (Fig 1). Conclusion Alemtuzumab induction therapy is associated with a low incidence of dnDSAs and AMR. Long-term outcome of these patients remains poor. [ABSTRACT FROM AUTHOR]

Purpose According to ISHLT increasing number of lung recipients receive induction therapy. Long-term data on the use of alemtuzumab are scarce, therefore, we aimed to review our experience and analyzed the impact of alemtuzumab. Methods Patients transplanted between 2007 and 2017, who received alemtuzumab were included in this retrospective single-center analysis. The following parameters were evaluated: survival, ACR, CLAD, malignancies and kidney function, infections incidence. Results Within the study period 525 patients received alemtuzumab as induction therapy. An episode of infection within the first year after LTx was reported in 358 patients (68%), however, only 216 of them (22%) needed hospitalization. In the same period 39 recipients (7.4%) died from infection complications. As one of the main advantages of induction therapy is the reduction of CNI, we analyzed rates of kidney insufficiency. During follow-up 94 patients (17.9%) developed kidney insufficiency (eGFR> 60 ml/min). Only two patients required chronic dialysis and one a kidney transplantation. At 1- and 5-years 98% and 97% patients were free from ACR. Three- and 5-years freedom rates from CLAD were 78.7% and 71.8%. Overall survival rates at 3- and 5-years were 79% and 74%, respectively. Conclusion This study shows that alemtuzumab is an effective induction agent with low incidence of severe infections and good survival rates. The associated reduction of CNI doses led to low incidence of kidney insufficiency and long freedom rates from severe CLAD. [ABSTRACT FROM AUTHOR]