BACKGROUND.: In a retrospective study of the first 75 primary renal transplant patients given alemtuzumab induction at our center, 20 were African American (27%), 32 were Hispanic (43%), and 23 were non-African American, non-Hispanic (31%). METHODS.: Alemtuzumab was given intraoperatively and 4 days later (0.3 mg/kg), with planned low-dose maintenance mycophenolate mofetil (500 mg twice daily) and tacrolimus (targeted trough levels of 5 to 7 ng/ml) and no corticosteroid therapy after the first week. Median follow-up among ongoing survivors with a functioning graft was 45 months. RESULTS.: Three-year actuarial patient and graft survival rates were 95% and 85% in African Americans, 89% and 78% in Hispanics, and 96% and 96% in non-African Americans, non-Hispanics, respectively (not significant). Bioavailability of tacrolimus was significantly lower among African Americans in comparison with the other patient subgroups (P</=.002). While the incidence of biopsy-proven acute rejection was 20% (4/20) in African Americans, 19% (6/32) in Hispanics, and 13% (3/23) in non-African American, non-Hispanic (not significant), chronic allograft dysfunction occurred more frequently among African Americans (10/20) in comparison with Hispanics (8/32) and non-African American, non-Hispanics (8/23) (P=0.08, log-rank test). In addition, there was a trend at 6 and 12 months posttransplant for the mean serum creatinine to be less favorable among African American patients (P=0.08 and 0.07). No group had increased infection or malignancy. CONCLUSIONS.: This immunosuppressive protocol appears reasonably safe for 3 years after renal transplantation but suggests higher incidences of biopsy-proven acute rejection, chronic allograft dysfunction, and borderline poorer renal function among African Americans in comparison with the other patient subgroups.

Ciancio G, Burke GW, Gaynor JJ, Sageshima J, Herrada E, Tueros L, Roth D, Kupin W, Rosen A, Esquenazi V, Miller J.

1 The Lillian Jean Kaplan Renal Transplant Center, Division of Transplantation, Department of Surgery, University of Miami Miller School of Medicine, Miami, FL. 2 Department of Medicine, Division of Nephrology, University of Miami Miller School of Medicine, Miami, FL.