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

Authors :
Engen RM
Bartosh SM
Source :
Pediatric transplantation [Pediatr Transplant] 2024 May; Vol. 28 (3), pp. e14753.
Publication Year :
2024

Abstract

Background: Alemtuzumab is a lymphocyte depleting agent used for induction in kidney transplant, but long-term information on its use in pediatric recipients remains sparse.<br />Methods: We performed a single-center retrospective cohort study of 57 pediatric kidney transplant recipients receiving alemtuzumab 20 mg/m <superscript>2</superscript> /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.<br />Results: Median 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.<br />Conclusions: A 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.<br /> (© 2024 The Authors. Pediatric Transplantation published by Wiley Periodicals LLC.)

Details

Language :
English
ISSN :
1399-3046
Volume :
28
Issue :
3
Database :
MEDLINE
Journal :
Pediatric transplantation
Publication Type :
Academic Journal
Accession number :
38623881
Full Text :
https://doi.org/10.1111/petr.14753