Preemptive Second Kidney Transplant Outcomes by Induction Type in the United States

Riad, Samy; Swanson, Kurtis J.; El-Rifai, Rasha; Larrieux, Gregory; Gylten, Logan; Jackson, Scott; Kandaswamy, Raja

doi:10.1016/j.transproceed.2022.08.026

Cited by 5 publications

(3 citation statements)

References 31 publications

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“…18 Conversely, Jain et al 19 reviewed 71 living and deceased pediatric kidney transplant recipients who received one dose of alemtuzumab and no maintenance corticosteroids with a reported 33.3% incidence of acute rejection, 7% incidence of CMV DNAemia and 28.8% incidence of BKPyV-DNAemia. In a review of adult preemptive second kidney transplants from the Scientific Registry of Transplant Recipients, Riad et al 20 reported a higher incidence of rejection with alemtuzumab (14.5%) compared to thymoglobulin (10.8%) or basiliximab (9%) but there was no difference in 10-year death-censored graft survival. This study only included living-donor transplants and was subject to the known incompleteness of induction and rejection data in SRTR.…”

Section: Backg Rou N Dmentioning

confidence: 99%

“…This study only included living-donor transplants and was subject to the known incompleteness of induction and rejection data in SRTR. 20,21 In 2003 our center began using two doses of alemtuzumab as induction immunosuppression with the goal of maintaining pediatric kidney transplant patients on a steroid-free maintenance immunosuppression program. Early results of the first four patients to receive this protocol were previously published, but long-term data is lacking.…”

Section: Backg Rou N Dmentioning

confidence: 99%

“…reported a higher incidence of rejection with alemtuzumab (14.5%) compared to thymoglobulin (10.8%) or basiliximab (9%) but there was no difference in 10‐year death‐censored graft survival. This study only included living‐donor transplants and was subject to the known incompleteness of induction and rejection data in SRTR 20,21 …”

Section: Introductionmentioning

confidence: 99%

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Long‐term outcomes of two‐dose alemtuzumab induction in pediatric kidney transplantation

Engen,

Bartosh

2024

Pediatric Transplantation

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BackgroundAlemtuzumab is a lymphocyte depleting agent used for induction in kidney transplant, but long‐term information on its use in pediatric recipients remains sparse.MethodsWe performed a single‐center retrospective cohort study of 57 pediatric kidney transplant recipients receiving alemtuzumab 20 mg/m2/dose ×2 doses for induction immunosuppression. All patients underwent surveillance biopsies, and 91.3% underwent steroid withdrawal by day 4 post‐transplant. Outcomes of interest included graft survival, development of donor specific antibodies (DSA), incidence of viremia and PTLD, and duration of lymphopenia.ResultsMedian follow‐up time was 7.9 years (IQR 5–13.6 years). Median graft survival was 16.5 years (95% CI 11.6‐unknown). DSA developed in 36.5% at a median of 944 days (IQR 252–2113 days). Incidences of BK polyomavirus DNAemia (BKPyV‐DNAemia), CMV DNAemia, and EBV DNAemia were 38.6%, 22.8%, and 14%, respectively; one patient developed PTLD at 13.3 years post‐transplant. Median duration of lymphopenia was 365 days (IQR 168–713 days); 19.3% of patients remained lymphopenic at 3 years post‐transplant. There was no association between duration of lymphopenia and graft survival, rejection, DSA detection, or viremia.ConclusionsA two‐dose alemtuzumab induction protocol can have excellent outcomes with a steroid‐free maintenance immunosuppression regimen. More comprehensive, multicenter, comparative studies of pediatric kidney transplant are needed to improve long‐term outcomes.

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Section: Backg Rou N Dmentioning

confidence: 99%

Section: Backg Rou N Dmentioning

confidence: 99%