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- Title
Long‐term outcomes of two‐dose alemtuzumab induction in pediatric kidney transplantation.
- Authors
Engen, Rachel M.; Bartosh, Sharon M.
- 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. Methods: We 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. 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. 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.
- Subjects
KIDNEY transplantation; ALEMTUZUMAB; LYMPHOPENIA; GRAFT survival; RENOVASCULAR hypertension; SURVIVAL rate; POLYOMAVIRUSES
- Publication
Pediatric Transplantation, 2024, Vol 28, Issue 3, p1
- ISSN
1397-3142
- Publication type
Article
- DOI
10.1111/petr.14753