2010 - TTS International Congress


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A New Century of Pediatric Transplantation?

94.5 - 63 Pediatric Living Donor Kidney Transplantations Using Alemtuzumab Pretreatment and Tacrolimus Monotherapy: 6 Year Experience

Presenter: ABHIDEEP, CHAUDHARY, Pittsburgh, United States
Authors: Tan H., CHAUDHARY A., DONALDSON J., Ellis D., Moritz M., Humar A., Basu A., Morgan C., Vats A., Erkan E., Swiatecka-Urban A., Barber A., Connors D., McFeaters C., Shapiro R.

63 PEDIATRIC LIVING DONOR KIDNEY TRANSPLANTATIONS USING ALEMTUZUMAB PRETREATMENT AND TACROLIMUS MONOTHERAPY: 6 YEAR EXPERIENCE

A NEW CENTURY OF PEDIATRIC TRANSPLANTATION?

H.P. Tan1, A. Chaudhary2, J. Donaldson1, D. Ellis3, M.L. Moritz3, A. Humar4, A. Basu1, C. Morgan1, A.N. Vats3, E. Erkan3, A. Swiatecka-urban3, A. Barber1, D. Connors1, C. Mcfeaters1, R. Shapiro1
1Surgery / Transplant, Thomas E. Starzl Transplantation Institute, Pittsburgh/PA/UNITED STATES OF AMERICA, 2Transplant Surgery, Thomas E. Starzl Transplantation Institute, Pittsburgh/PA/UNITED STATES OF AMERICA, 3Nephrology, Childrens Hospital Of Pittsburgh of UPMC, Pittsburgh/UNITED STATES OF AMERICA, 4Department Of Surgery, Thomas E. Starzl Transplantation Institute, Pittsburgh/PA/UNITED STATES OF AMERICA

Body:
Introduction: We have previously reported that alemtuzumab (Campath 1-H) pre-treatment with tacrolimus monotherapy provides effectiveimmunosuppression for solid organ transplantation.

Methods: We extend our report of alemtuzumab (0.4-0.5 mg/kg) pretreatment with tacrolimus monotherapy to a 6-year experience of 63 consecutive pediatric living donor kidney transplantations(LDKT, donor kidneys were removed laparoscopically [LLDN]) between January 2004 and November 2009. The mean follow up was 30.5+21.0 mos

Results: The mean donor and recipient ages were 35.9+8.9 and 8.8+5.9 years, with 6 re-transplants. ABDR mismatch was 2.7+1.2. There was no DGF. The patient survivals at1-, 2-, 3-, 4-, and 5-yrs were 98.3%, 95.9%, 95.9%, 95.9%, and 95.9%, respectively. Graft survivals at 1-, 2-, 3-, 4-, and 5-yrs were 94.6%, 84.5%, 80.8%, 75.5%, and 75.5% respectively. Weaning wasattempted in 27.4% of patients and was put on temporary hold in Mar 2007. The cumulative incidence of biopsy-proven acute cellular rejection (ACR) was 0.0%, 1.6%, 4.8%, 6.5%, and 8.1% at 1-, 2-, 3-,4-, and 5-year. Out of 23 patients who were biopsied a total of 10 ACR episodes in 5 patients were diagnosed and these episodes were steroid sensitive. No patients had AMR. Because no protocolbiopsies were performed we could not determine the degree of progression of IF/TA. The GFR (mL/min/1.73m2) at 1-, 2-, 3-, 4-, and 5-yrs were 94+33, 89+35, 85+24,88+36, and 92+47, respectively. 92% of patients are still on tacrolimus monotherapy (steroid-free). One patient had excellent graft function at the time of death. Most graft loss wasnot related to ACR (3 graft loss from vascular thrombosis, 2 graft loss from delayed vascular torsion of intraperitoneal kidneys, 2 graft loss from recurrent FSGS). There were no cases of CMVdisease. Two patients developed asymptomatic BK infections (viruria but not viremia). One patient developed PTLD.

Conclusion: This study represents the largest series to date of unselected pediatric LDKT using alemtuzumab pretreatment, and confirms the mid-term safety and efficacy of this approach. LLDNis not a risk factor for DGF or ACR in pediatric kidney transplant recipients.

Disclosure: All authors have declared no conflicts of interest.


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