Alemtuzumab Induction in Pediatric Kidney Transplantation

Abstract

Recipient parenchymal lymphatic cells are crucial for direct and indirect pathways of allorecognition. We proposed that alemtuzumab, being infused several weeks pretransplant could eradicate peripheral lymphatic cells and promote donor-specific tolerance. We present here a single center, retrospective review of 101 consecutive living-donor kidney transplantations to pediatric patients aged from seven month to 18 yr, performed between September 2006 and April 2010. Immunosupression protocol included two 30 mg doses of alemtuzumab: first given 12-29 d prior to transplantation and second at the time of transplantation. Maintenance immunosupression was based on combination of low dose and wide range CNI and mycophenolate. Patients were followed for 3.8 AE 1.4 yr and protocol biopsies were taken one month, one, and three yr post transplant. The Kaplan-Meier graft and patient survival was 96% and 97% for one yr, 89% and 93% for three yr. Biopsy proven acute rejection developed in 26% patients at one yr and in 35% at two yr, no rejections occurred beyond two yr. We conclude that alemtuzumab pretreatment prior to living related donor kidney transplantation allows to reach satisfactory middle-term results in pediatric patients with wide range and low CNI concentrations.

Primary pediatric deceased‐donor kidney transplant recipients outcomes by immunosuppression induction received in the United States

“…Many trials have focused on short‐ or intermediate‐term outcomes such as six‐month and one‐year acute rejection without sufficient data on the long‐term consequences. Single‐center experiences with depletional agents such as anti‐thymocyte globulin 8‐10 and alemtuzumab 11‐14 opened door to widespread acceptance across the US transplant programs.…”

Inmunosupresores y principales complicaciones en el trasplante renal pediátrico

“…Según lo informado por Calne y colaboradores (16), se lo ha utilizado como terapia de inducción en trasplante renal en niños desde 1998. Ha mostrado resultados satisfactorios en la terapia de inducción en el trasplante renal pediátrico (3,(17)(18)(19)(20)(21)(22)(23). Estudios de alemtuzumab han revelado beneficios en los pacientes de bajo y alto riesgo inmunológico (24).…”