Steroid-free maintenance immunosuppression using alemtuzumab in pediatric kidney transplantation

Background: There is a scarcity of long-term data on steroid-free immunosuppression using alemtuzumab in pediatric kidney transplantation (KTx). This study examines long-term outcomes with alemtuzumab without steroid maintenance therapy in pediatric KTx. Methods: From July 2005 to June 2015, 71 pediatric KTx recipients received alemtuzumab without steroid maintenance. They were followed from 4.1 to 14.1 years post KTx. Results: Patient survival: One child expired with a functioning graft from post-transplant lymphoproliferative disorder (PTLD). Patient survival was 98.6%. Graft survival: Eighteen grafts were lost (16 from chronic rejection). Graft survival at 5 and 10 years was 92.3% and 61.3%, respectively. Rejection: Twenty-three (32.4%) patients were free from T-cell-mediated rejection (TCMR), 16 (22.5%) had >3 episodes. Sixteen (22.5%) were treated for antibody-mediated rejection (AMR). Infection: Twenty-three children developed Epstein-Barr virus (EBV), 5 developed cytomegalovirus (CMV), and 20 developed BK virus infection. Four (5.6%) developed PTLD. Twenty-two (31.0%) required treatment for neutropenia. Growth parameters: Mean height and weight increased by 0.56 and 0.69 SDS (standard deviation score), respectively. Body mass index increased by 5.1 kg/m2 at 10 years. Less than 40% required antihypertensive medications at all-time points. Conclusion: Alemtuzumab, without corticosteroid maintenance, offers 98.6% patient survival at 14 years with five and 10-year graft survival of 92.3% and 61.3%, respectively. TCMR and AMR requiring treatment were 67.4% and 22.5%, respectively. CMV, EBV, and BK viremia rates were 7.0%, 32.4%, and 28.2%, respectively. Thirty-one percent were treated for neutropenia; 5.6% developed PTLD. There were improvements in growth parameters and blood pressure.

This is the peer reviewed version of the following article: Jain, A, Daoud, D, Kees-Folts, D, et al. Steroid-free maintenance immunosuppression using alemtuzumab in pediatric kidney transplantation: Long-term longitudinal follow-up. Pediatr Transplant. 2021; 00:e14173, which has been published in final form at https://doi.org/10.1111/petr.14173. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. This article may not be enhanced, enriched or otherwise transformed into a derivative work, without express permission from Wiley or by statutory rights under applicable legislation. Copyright notices must not be removed, obscured or modified. The article must be linked to Wiley’s version of record on Wiley Online Library and any embedding, framing or otherwise making available the article or pages thereof by third parties from platforms, services and websites other than Wiley Online Library must be prohibited.

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Work Title Steroid-free maintenance immunosuppression using alemtuzumab in pediatric kidney transplantation
Subtitle Long-term longitudinal follow-up
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Open Access
Creators
  1. Ashokkumar Jain
  2. Deborah Daoud
  3. Deborah Kees-Folts
  4. Michael Freeman
  5. Fauzia Butt
  6. Catherine S. Abendroth
  7. Hiroko Shike
  8. Zakiyah Kadry
License In Copyright (Rights Reserved)
Work Type Article
Publisher
  1. Pediatric Transplantation
Publication Date October 23, 2021
Publisher Identifier (DOI)
  1. https://doi.org/10.1111/petr.14173
Deposited December 10, 2021

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  • Created
  • Added Alemtuzumab_first_submission__1_.pdf
  • Added Creator Ashokkumar Jain
  • Added Creator Deborah Daoud
  • Added Creator Deborah Kees-Folts
  • Added Creator Michael Freeman
  • Added Creator Fauzia Butt
  • Added Creator Catherine S. Abendroth
  • Added Creator Hiroko Shike
  • Added Creator Zakiyah Kadry
  • Published
  • Updated
  • Updated