Clinical Description and Evolution of Renal Transplant Pediatric Patients Treated with Alemtuzumab

Vélez, Claudia Marcela; Zuluaga, Gustavo; Ocampo, Catalina; Aristizábal, Arbey; Serna, Lina; Gayubo, Ana Katherina Serrano; Flórez, Jonathan Zapata; Zuleta, John Jairo; Ruiz, Juan José Vanegas

doi:10.1016/j.transproceed.2011.09.101

Cited by 6 publications

(8 citation statements)

References 16 publications

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“…Our youngest HS patient to receive alemtuzumab induction was 2 years old at the time of transplant, and at 4 years posttransplant, she continues to have good graft function with a creatinine of 0.8 mg/dL. Like prior studies examining alemtuzumab induction in pediatric patients, 17,[25][26][27][28][29][30] alemtuzumab was well tolerated with no patient deaths or significant difference in graft loss compared with nonsensitized patients receiving anti-IL-2R induction in our pediatric patients.…”

Section: Discussionmentioning

confidence: 63%

Safety and Efficacy of Alemtuzumab Induction in Highly Sensitized Pediatric Renal Transplant Recipients

Kim

Choi

et al. 2017

Transplantation

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Alemtuzumab induction with desensitization led to nearly equivalent graft survival and functional outcomes in HS pediatric patients as nonsensitized patients receiving anti-IL-2R induction. With this small sample size, we observed significant reduction of white blood cell and absolute lymphocyte count up to 1 year posttransplant. The risk of infection was comparable between the 2 groups; however, patients who received alemtuzumab were older and at lower risk of viral infection due to serostatus.

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Section: Discussionmentioning

confidence: 63%

Safety and Efficacy of Alemtuzumab Induction in Highly Sensitized Pediatric Renal Transplant Recipients

Kim

Choi

et al. 2017

Transplantation

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“…In particular, the minimization of glucocorticoids, which can cause, among others growth retardation, post-transplant diabetes mellitus, and weight gain, is an important goal in this population. Induction therapy with alemtuzumab has been used incidentally to avoid glucocorticoids and reduce calcineurin inhibitor exposure but no prospective, randomized controlled clinical trials comparing different induction therapies have been performed in children [ 74 – 83 ]. Several reasons may exist why limited studies have been performed with alemtuzumab in children.…”

Section: Clinical Use Of Alemtuzumab In Kidney Transplantationmentioning

confidence: 99%

Review of the Clinical Pharmacokinetics and Pharmacodynamics of Alemtuzumab and Its Use in Kidney Transplantation

et al. 2017

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Alemtuzumab is a humanized monoclonal antibody against CD52 and causes depletion of T and B lymphocytes, monocytes, and NK cells. Alemtuzumab is registered for the treatment of multiple sclerosis (MS) and is also used in chronic lymphocytic leukemia (CLL). Alemtuzumab is used off-label in kidney transplantation as induction and anti-rejection therapy. The objective of this review is to present a review of the pharmacokinetics, pharmacodynamics, and use of alemtuzumab in kidney transplantation. A systematic literature search was conducted using Ovid Medline, Embase, and Cochrane Central Register of controlled trials. No pharmacokinetic or dose-finding studies of alemtuzumab have been performed in kidney transplantation. Although such studies were conducted in patients with CLL and MS, these findings cannot be directly extrapolated to transplant recipients, because CLL patients have a much higher load of CD52-positive cells and, therefore, target-mediated clearance will differ between these two indications. Alemtuzumab used as induction therapy in kidney transplantation results in a lower incidence of acute rejection compared to basiliximab therapy and comparable results as compared with rabbit anti-thymocyte globulin (rATG). Alemtuzumab used as anti-rejection therapy results in a comparable graft survival rate compared with rATG, although infusion-related side effects appear to be less. There is a need for pharmacokinetic and dose-finding studies of alemtuzumab in kidney transplant recipients to establish the optimal balance between efficacy and toxicity. Furthermore, randomized controlled trials with sufficient follow-up are necessary to provide further evidence for the treatment of severe kidney transplant rejection.Electronic supplementary materialThe online version of this article (doi:10.1007/s40262-017-0573-x) contains supplementary material, which is available to authorized users.

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“…The following data were extracted: rst author, country of author, year of publication, interventions, dosage of drugs, number of participants and outcome measures. In the studies that included a third group other than anti-IL-2R antibodies or ATG/ALG, only data of the 2 groups were extracted [9][10][11].…”

Section: Data Extractionmentioning

confidence: 99%

Comparison of induction therapy with anti-thymocyte/antilymphocyte globulin or anti-IL-2 receptor antibody in pediatric kidney transplantation: a systematic review and meta-analysis

Lin¹,

Deng²,

Hong³

et al. 2021

Preprint

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BackgroundAnti-IL-2 antibody (basiliximab or daclizumab) and anti-thymocyte globulin (ATG)/antilymphocyte globulin (ALG) are widely used as induction agents in pediatric kidney transplantation. However, which of them benefits patients more remains unknown.MethodsOnline databases were searched to identify controlled clinical studies that compared anti-IL-2 with ATG/ALG for induction therapy in pediatric kidney transplantation. Odds ratios (OR) and 95% confidence interval (CI) were chosen to compare the gathered data. Review Manager 5.4 was applied to identify differences in outcomes between the two agents.ResultsFive retrospective cohort studies were included, enrolling a total of 2510 pediatric patients, 1152 (45.7%) of whom had received ATG/ALG therapy and 1370 (54.3%) of whom received anti-IL-2. According to the pooled results, no differences were seen between anti-IL-2 and ATG/ALG regarding the delayed graft function (DGF) rate (odds ratio (OR) 1.1; 95% confidence interval (CI) 0.36–3.39; P = 0.85), 6-month acute rejection rate (OR 0.80; 95% CI 0.62–1.03; P = 0.09), 1-year acute rejection rate (OR 0.98; 95% CI 0.78–1.24; P = 0.88), 1-year graft survival rate (OR 1.37; 95% CI 0.91–2.06; P = 0.13), 1-year patient survival rate (OR 0.86; 95% CI 0.40–1.86; P = 0.70) and 1-year post-transplantation lymphoproliferative disorder (PTLD) rate (OR 0.30; 95% CI 0.03–3.16; P = 0.32).ConclusionsAnti-IL-2 have the same efficacy and safety as ATG/ALG in transplant induction therapy. However, as most of included studies were small-scale retrospective studies, further studies are needed to identify an optimal choice with certain.The analysis had been registered in PROSPERO and the registration ID is CRD42021237561. Comparison of induction therapy with anti-thymocyte/antilymphocyte globulin or anti-IL-2 receptor antibody in pediatric kidney transplantation: a systematic review and meta-analysis

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Clinical Description and Evolution of Renal Transplant Pediatric Patients Treated with Alemtuzumab

Cited by 6 publications

References 16 publications

Safety and Efficacy of Alemtuzumab Induction in Highly Sensitized Pediatric Renal Transplant Recipients

Safety and Efficacy of Alemtuzumab Induction in Highly Sensitized Pediatric Renal Transplant Recipients

Review of the Clinical Pharmacokinetics and Pharmacodynamics of Alemtuzumab and Its Use in Kidney Transplantation

Comparison of induction therapy with anti-thymocyte/antilymphocyte globulin or anti-IL-2 receptor antibody in pediatric kidney transplantation: a systematic review and meta-analysis

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