Cited by 151Renal Transplantation Outcomes and TreatmentsTransplantation: Methods and OutcomesOrgan and Tissue Transplantation Research

Alemtuzumab-based induction treatment versus basiliximab-based induction treatment in kidney transplantation (the 3C Study): a randomised trial

†·2014·The Lancet

Abstract

Background Calcineurin inhibitors (CNIs) reduce short-term kidney transplant failure, but might contribute to transplant failure in the long-term. The role of alemtuzumab (a potent lymphocyte-depleting antibody) as an induction treatment followed by an early reduction in CNI and mycophenolate exposure and steroid avoidance, after kidney transplantation is uncertain. We aimed to assess the efficacy and safety of alemtuzumab-based induction treatment compared with basiliximab-based induction treatment in patients receiving kidney transplants.Methods For this randomised trial, we enrolled patients aged 18 years and older who were scheduled to receive a kidney transplant in the next 24 h from 18 transplant centres in the UK. Using minimised randomisation, we randomly assigned patients (1:1; minimised for age, sex, and immunological risk) to either alemtuzumab-based induction treatment (ie, alemtuzumab followed by low-dose tacrolimus and mycophenolate without steroids) or basiliximab-based induction treatment (basiliximab followed by standard-dose tacrolimus, mycophenolate, and prednisolone). Participants were reviewed at discharge from hospital and at 1, 3, 6, 9, and 12 months after transplantation. The primary outcome was biopsy-proven acute rejection at 6 months, analysed by intention to treat. The study is registered at ClinicalTrials.gov, number NCT01120028, and isrctn.org, number ISRCTN88894088.Findings Between Oct 4, 2010, and Jan 21, 2013, we randomly assigned 852 participants to treatment: 426 to alemtuzumab-based treatment and 426 to basiliximab-based treatment. Overall, individuals allocated to alemtuzumab-based treatment had a 58% proportional reduction in biopsy-proven acute rejection compared with those allocated to basiliximab-based treatment (31 [7%] patients in the alemtuzumab group vs 68 [16%] patients in the basiliximab group; hazard ratio (HR) 0·42, 95% CI 0·28-0·64; log-rank p<0·0001). We detected no between-group difference in treatment effect on transplant failure during the first 6 months (16 [4%] patients vs 13 [3%] patients; HR 1·23, 0·59-2·55; p=0·58) or serious infection (135 [32%] patients vs 136 [32%] patients; HR 1·02, 0·80-1·29; p=0·88). During the first 6 months after transplantation, 11 (3%) patients given alemtuzumab-based treatment and six (1%) patients given basiliximab-based treatment died (HR 1·79, 95% CI 0·66-4·83; p=0·25).Interpretation Compared with standard basiliximab-based treatment, alemtuzumab-based induction therapy followed by reduced CNI and mycophenolate exposure and steroid avoidance reduced the risk of biopsy-proven acute rejection in a broad range of patients receiving a kidney transplant. Long-term follow-up of this trial will assess whether these effects translate into differences in long-term transplant function and survival.Funding UK National Health Service Blood and Transplant Research and Development Programme, Pfizer, and Novartis UK.

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Crossref · 10.1016/s0140-6736(14)61095-3

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Authors
†
Corresponding author
†
Venue
The Lancet
Publisher
Elsevier BV
Published
2014-11
Volume
384
Issue
9955
Pages
1684-1690
ISSN
  • 0099-5355 (ISSN-L)
  • 0140-6736
OpenAlex
W2186473865
Cited by
149
References
25
Citations by year
2026: 5 · 2025: 10 · 2024: 6 · 2023: 6 · 2022: 11 · 2021: 8 · 2020: 15 · 2019: 13 · 2018: 17 · 2017: 19 · 2016: 16 · 2015: 17 · 2014: 6
FWCI
19.86
Type
journal article
Language
en
Open access
closed
Locations
  • The Lancet (publishedVersion)
  • PubMed (publishedVersion)
  • ORCA Online Research @Cardiff (Cardiff University) (submittedVersion)
Funders
Pfizer Ltd and Novartis Pharmaceuticals UK Ltd, and by NHS Blood and Transplant (project reference 09-15-01-03)
Topics
  • Health Sciences › Medicine › Transplantation › Renal Transplantation Outcomes and Treatments
  • Health Sciences › Medicine › Surgery › Transplantation: Methods and Outcomes
  • Health Sciences › Medicine › Transplantation › Organ and Tissue Transplantation Research
Keywords
alemtuzumab, basiliximab, kidney transplantation, induction therapy, acute rejection, calcineurin inhibitors, tacrolimus, mycophenolate, steroid avoidance, transplant failure, lymphocyte depletion, immunosuppression, renal allograft survival, acute kidney injury, acute tubular necrosis, acute interstitial nephritis
MeSH terms
Alemtuzumab, Basiliximab, Adult, Antibodies, Monoclonal, Female, Graft Rejection, Humans, Immunosuppressive Agents, Male, Opportunistic Infections, Recombinant Fusion Proteins, Kidney Transplantation, Antibodies, Monoclonal, Humanized

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