PEDIATRICS

J. Ibañez, M. Monteverde, A. Chaparro, M. Diaz, A. Turconi
Nefrologia, Hospital de Pediatria Dr. Juan P. Garrahan, Buenos Aires/ARGENTINA

Body: Induction therapy (IT) implies the begining of intense immunosuppression (IS) at time of transplantation (Tx) in order to achieve the minimal incidence and severity of acute rejection (AR) episodes and to delay calcineurin inhibitors introduction when tubular acute necrosis is present. Several agents have been used for IT. Thymoglobulin (TMG) is a lymphocyte-depleting agent employed for IT and AR treatment. The aim of the study was assessment of short-term (12 months) efficacy and security of TMG for IT in pediatric renal Tx (RTx) recipients. Records of 190 patients who underwent RTx between March 2003 and January 2009 at our institution were reviewed. Elegible patients for analysis were: first deceased donor RTx recipients; maintenance IS based on Neoral, MMF-MPS or AZA and Steroids during the first year post Tx. Patients with CRF secundary to atipic HUS or focal and segmental glomerulosclerosis were not included. Initial TMG dose was begun immediatly post chirurgical implant and succesive doses were indicated according peripheral blood lymphocytes count until C₂ Neoral level reached 1100 to 1300 ng/ml. Results: 115 patients (64 males and 51 females) were analyzed. Mean recipients age was 11,5 +/- 3.6 years; mean donor age was 20 +/- 10.8 years; mean cold isquemia time 20.7+/- 5.3 hs; mean HLA-A MM 1.31 +/- 0.65; mean HLA-B MM 1.42 +/- 0.57 and mean HLA-DR MM 0.61 +/- 0.5. Fourteen percent patients were CMV IgG (-) and 7.8 % EBV IgG (-). During IT patients received mean 5.2 +/- 2.7 TMG doses and mean full dose of TMG was 11.4 +/- 4.8 mg/kg.There were 11 (9.5%) biopsy-proben AR episodies in 10 patients. According Banff 07 criteria, 9 were borderline; 1 Banff 1B and 1 borderline plus positive C4D. Non-compliance was evident in two adolescents who experience most severe rejections. At 12 months patients survival was 100%, graft survival 99.1% and glomerular filtration rate 79.4 +/- 22.2 ml/min/1.73m² estimated by Schwarzt formula. Twentynine patients (25.2%) experienced no adverse events. In 86 patients (74.8%) there were 181 adverse events. Thirtytwo patients (27.8%) received treatment for CMV and 4 patients (3.5%) developed PTLD (2 hyperplasia plasmocytic, 1 B-cell lymphoma and 1 polyclonal polymorpha). Urinary tract infection was the more frecuent complication occurring in patients with urinary tract malformations. Diarrhea and fever of unknown etiology also were very frequent. Conclusion: despite the incidence of adverse events is of concern, TMG IT was effective in combination with Neoral, MMF-MPS or AZA and Steroids for preventing rejections in the first year post RTx in our pediatric population.

Disclosure: All authors have declared no conflicts of interest.