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 ± 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.

Alemtuzumab with corticosteroid minimization for pediatric deceased donor renal transplantation: A seven‐yr experience

“…We have only had one case of CMV viremia and no cases of BK nephropathy despite that our patients continue to be on both calcineurin inhibitor and MMF. Compared to the literature, our infectious complications appear to be lower than reported, but this could be related to our small number of patients . In this study, we show graft survival of 95% and patient survival of 100% at seven yr.…”

“…Four-yr follow-up showed promising results in terms of safety, efficacy, and tolerability (13). Kaabak et al (14) modified the Pittsburgh protocol by giving the first dose of alemtuzumab two to three wk prior to living donor kidney transplantation and the second dose on the day of transplantation to achieve maximal lymphocyte depletion. Their results also revealed promising patient and graft survival rates using this strategy.…”

Challenges in pediatric renal transplantation

“…Recent RCT in adults have shown lower frequency of acute rejection in comparison to basiliximab in patients non at high immunological risk [18,19] . In children the first relevant experience was from Kidney Transplantation Center in Moskow, as Kaabak et al [20] reported, in living related pediatric renal transplants. The rationale was to eradicate peripheral lymphomonocytes and induce donor-specific tolerance, by infusing two doses of 30 mg alemtuzumab, one 12-29 d prior to transplantation and the other at surgery.…”

Demographic Geography of Kidney Transplantation in Children in Russia

“…The specialists are primarily interested in the long-term transplantation results and the factors that affect them. There are only few publications on kidney transplantation in Russia [1][2][3][4]. We would like to bring forward the long-term results of pediatric kidney transplantations not in the traditional form of Kaplan-Meier actuarial survivability estimator, but in the form of the number of people with functioning transplants, who had received their first transplants in childhood.…”