OBJECTIVE: Describe the safety and efficacy of antithymocyte globulin or alemtuzumab preconditioning, steroid avoidance and reduced calcineurin inhibitor (CNI) immunosuppression in 34 children undergoing renal transplantation. METHODS: ATG (n=8) or alemtuzumab (n=26) were infused at the time of transplantation. This was followed by low-dose twice a day tacrolimus monotherapy with consolidation to once daily dosing by 6 months and once every other day dosing by 12 months. Follow-up ranged from 0.5-2.9 years (mean 1.33 years), with a minimum of 6 months. RESULTS: Both ATG and alemtuzumab were well tolerated. Lymphopenia occurred routinely and resolved after 3-6 months. Acute cellular rejection occurred in 9%; it was related to medical nonadherence in two patients and resulted in one graft loss at 1.5 years. Important adverse events included transient neutropenia in 10 children (none with serious infection), and autoimmune hemolytic anemia in two (resolved with a steroid course in both and conversion to sirolimus in one). Estimated glomerular filtration rate (e-GFR) was stable and averaged 88 mL/min/1.73 m2 at latest follow-up. Fifteen preadolescents had a greater increase in height Z-score at 1 year (1.3 vs. 0.5, P=0.001), and a higher e-GFR (94.8+/-21 vs. 76.6+/-20 ml/min/1.73 m2, P<0.05), when compared to case-matched historical controls who were weaned off steroids by 6 months after transplantation and received twice daily tacrolimus monotherapy. CONCLUSION: This simple regimen appears safe, has a low risk for acute cellular rejection or other adverse effects, and is associated with excellent growth and renal function. Such a regimen may also improve compliance and limit CNI nephrotoxicity.
OBJECTIVE: Describe the safety and efficacy of antithymocyte globulin or alemtuzumab preconditioning, steroid avoidance and reduced calcineurin inhibitor (CNI) immunosuppression in 34 children undergoing renal transplantation. METHODS: ATG (n=8) or alemtuzumab (n=26) were infused at the time of transplantation. This was followed by low-dose twice a day tacrolimus monotherapy with consolidation to once daily dosing by 6 months and once every other day dosing by 12 months. Follow-up ranged from 0.5-2.9 years (mean 1.33 years), with a minimum of 6 months. RESULTS: Both ATG and alemtuzumab were well tolerated. Lymphopenia occurred routinely and resolved after 3-6 months. Acute cellular rejection occurred in 9%; it was related to medical nonadherence in two patients and resulted in one graft loss at 1.5 years. Important adverse events included transient neutropenia in 10 children (none with serious infection), and autoimmune hemolytic anemia in two (resolved with a steroid course in both and conversion to sirolimus in one). Estimated glomerular filtration rate (e-GFR) was stable and averaged 88 mL/min/1.73 m2 at latest follow-up. Fifteen preadolescents had a greater increase in height Z-score at 1 year (1.3 vs. 0.5, P=0.001), and a higher e-GFR (94.8+/-21 vs. 76.6+/-20 ml/min/1.73 m2, P<0.05), when compared to case-matched historical controls who were weaned off steroids by 6 months after transplantation and received twice daily tacrolimus monotherapy. CONCLUSION: This simple regimen appears safe, has a low risk for acute cellular rejection or other adverse effects, and is associated with excellent growth and renal function. Such a regimen may also improve compliance and limit CNI nephrotoxicity.
Authors: Irfan A Agha; Jose Rueda; Alejandro Alvarez; Gary G Singer; Brent W Miller; Karen Flavin; Jeffrey A Lowell; Surendra Shenoy; Todd K Howard; Venkataraman Ramachandran; William Irish; Mark A Schnitzle; Daniel C Brennan Journal: Transplantation Date: 2002-02-15 Impact factor: 4.939
Authors: R Calne; S D Moffatt; P J Friend; N V Jamieson; J A Bradley; G Hale; J Firth; J Bradley; K G Smith; H Waldmann Journal: Transplantation Date: 1999-11-27 Impact factor: 4.939
Authors: Ron Shapiro; Demetrius Ellis; Henkie P Tan; Michael L Moritz; Amit Basu; Abhay N Vats; Akhtar S Khan; Edward A Gray; Adrianna Zeevi; Corde McFeaters; Gerri James; Mary Jo Grosso; Amadeo Marcos; Thomas E Starzl Journal: J Pediatr Date: 2006-06 Impact factor: 4.406
Authors: Sayeed K Malek; Melissa A Obmann; Robert A Gotoff; Michael A Foltzer; James E Hartle; Santosh Potdar Journal: Transplantation Date: 2006-01-15 Impact factor: 4.939
Authors: Ron Shapiro; Mark L Jordan; Amit Basu; Velma Scantlebury; Santosh Potdar; Henkie P Tan; Edward A Gray; Parmjeet S Randhawa; Noriko Murase; Adriana Zeevi; Anthony J Demetris; Jennifer Woodward; Amadeo Marcos; John J Fung; Thomas E Starzl Journal: Ann Surg Date: 2003-10 Impact factor: 12.969