2117 PEDIATRIC STEROID-FREE DECEASED-DONOR RENAL TRANSPLANTATION WITH ALEMTUZUMAB INDUCTION: A SEVEN-YEAR EXPERIENCE

Abstract

You have accessJournal of UrologyTransplantation & Vascular Surgery: Renal Transplantation, Renal Vascular Surgery1 Apr 20132117 PEDIATRIC STEROID-FREE DECEASED-DONOR RENAL TRANSPLANTATION WITH ALEMTUZUMAB INDUCTION: A SEVEN-YEAR EXPERIENCE Jonathan J. Melquist, Heather N. DiCarlo, Deirdre Connolly, Joseph Caputo, Richard Fine, Katarina Supe-Markovina, Wayne C. Waltzer, and Frank S. Darras Jonathan J. MelquistJonathan J. Melquist Stony Brook, NY More articles by this author , Heather N. DiCarloHeather N. DiCarlo Baltimore, MD More articles by this author , Deirdre ConnollyDeirdre Connolly Stony Brook, NY More articles by this author , Joseph CaputoJoseph Caputo Stony Brook, NY More articles by this author , Richard FineRichard Fine Stony Brook, NY More articles by this author , Katarina Supe-MarkovinaKatarina Supe-Markovina Stony Brook, NY More articles by this author , Wayne C. WaltzerWayne C. Waltzer Stony Brook, NY More articles by this author , and Frank S. DarrasFrank S. Darras Stony Brook, NY More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2026AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Alemtuzumab (Campath-1H, C1H) is a monoclonal antibody targeting CD52 receptors on B- and T-lymphocytes and is an effective induction agent in renal transplantation. We report a seven-year experience using C1H induction and steroid-free protocol in the pediatric population as safe and effective. METHODS Between 2006 and 2012, 21 pediatric deceased-donor renal transplants were performed at a single academic center. Mean recipient age was 14.3 years (range 4 - 18). Six of the 21 recipients were African-American, 8 were Hispanic, 7 were Caucasian, 14 were male, and 3 were re-transplants. All 21 pediatric recipients received a single intraoperative dose of alemtuzumab (0.6 mg/kg, range 10-30 mg), 3 doses of IV methylprednisolone, tacrolimus (TAC), and low-dose mycophenolate mofetil (MMF). Immunosuppression was maintained using TAC and MMF. RESULTS The average follow-up period was 32 months. All patients had immediate graft function. Graft survival was 95% and patient survival was 100%. Mean 12- and 36-month eGFR were 60.3±28.9 and 56.4±14.4 mL/min/1.73m2, respectively. Two patients developed acute T-cell mediated rejection on average 10.5 months from transplantation (See Figure). One was treated successfully. The other one had a transplant nephrectomy at 20 months for graft failure believed to be secondary to the patient's persistent non-compliance with the immunosuppression regimen. No pediatric recipients developed cytomegalovirus (CMV) infection, post-transplant lymphoproliferative disease (PTLD) or Polyoma BK viral nephropathy. No cases of post-transplant diabetes mellitus (PTDM) or hyperlipidemia have been seen in this group. All 21 patients stayed on TAC and low-dose MMF throughout their post-transplant course. CONCLUSIONS Steroid-free immunosuppression with single dose C1H induction provides adequate and safe immunosuppression in pediatric deceased-donor renal transplant recipients receiving TAC and low-dose MMF maintenance therapy. These results compare favorably with our adult renal transplant experience. The authors plan to continue their current steroid-free protocol in existing and future patients. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e867-e868 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jonathan J. Melquist Stony Brook, NY More articles by this author Heather N. DiCarlo Baltimore, MD More articles by this author Deirdre Connolly Stony Brook, NY More articles by this author Joseph Caputo Stony Brook, NY More articles by this author Richard Fine Stony Brook, NY More articles by this author Katarina Supe-Markovina Stony Brook, NY More articles by this author Wayne C. Waltzer Stony Brook, NY More articles by this author Frank S. Darras Stony Brook, NY More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...