2010 - TTS International Congress


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Induction Immunosuppression

89.9 - One year follow up efficacy and safety of induction therapy comparison of anti-interleukin-2 receptor antibodies and thymoglobulin

Presenter: Li, Li, Stanford, United States
Authors: Li L., Chaudhuri A., Chen A., Zhao X., Bezchinsky M., Sarwal M.

ONE YEAR FOLLOW UP EFFICACY AND SAFETY OF INDUCTION THERAPY COMPARISON OF ANTI-INTERLEUKIN-2 RECEPTOR ANTIBODIES AND THYMOGLOBULIN

INDUCTION IMMUNOSUPPRESSION

L. Li1, A. Chaudhuri2, A. Chen2, X. Zhao2, M. Bezchinsky2, M. Sarwal2
1Pediatric, Stanford University, Stanford/CA/UNITED STATES OF AMERICA, 2, Stanford University, stanford/UNITED STATES OF AMERICA

Body: Aim: To evaluate the safety and efficacy of an alternative steroid-free protocol in pediatric kidney transplantation, using thymoglobulin (TMG) vs. a 6 mo course of extended Daclizumab (Ext-DAC). Methods: This study reports a single center retrospective analysis of 26 consecutive pediatric renal transplant patients from Oct 2008 to Oct 2010 on a steroid-free protocol with MMF and tacrolimus; 13 received Ext-DAC and 13 received TMG inductions with 6 doses of 1.5 mg/kg/dose. Protocol biopsies were done in all patients at 0,3,6,12,24 mos. All patients were measured at QPCR for CMV, EBV, and BK at serial post-txp times. All patients received antiviral prophylaxis regardless or risk stratification for 3 mo for children >5 yrs and for 12 mo for children < 5yrs. All statistical analyses were performed using the SAS 9.2.1. Time series data was analyzed by repeated measures mixed model. Results: Graft survival was 100% in both groups. There was no DGF in either group. None of the patients experienced clinical or sub-clinical AR. There was no significant difference for graft function (p=0.23). The absolute lymphocyte counts were lower over the first year in the TMG induction group (F = 5.04, mixed model group effect p = 0.03, Figure 1). There is no significant difference for neutrophils (p =0.40) and WBC absolute counts (p =0.56) between groups at any time point. Subclinical CMV viremia was higher in the TMG group (15% vs. 0%; p = 0.14) as was BK viremia (17% vs. 0%; p=0.14). There was no difference for subclinical EBV viremia (23% for TMG vs. 31% for Ext-DAC; p = 0.65). Conclusion: Thymoglobulin induction can be an alternative induction strategy to replace Ext-DAC for steroid-free immunosuppression in pediatric renal transplantation, as there is equivalence with excellent results for AR, graft function and graft survival. The trend towards more viral infection and lymphopenia needs careful consideration, and a reduction in the TMG exposure may be necessary to improve the index of safety with the TMG, steroid-free regimen.

Disclosure: All authors have declared no conflicts of interest.


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