Eight‐year follow‐up in pediatric living donor kidney recipients receiving alemtuzumab induction
Recipient lymphocytes are crucial for direct and indirect pathways of allorecognition. We proposed that the administration of alemtuzumab several weeks pretransplantation could eradicate peripheral lymphatic cells and promote donor‐specific acceptance. This was a single‐center, retrospective review...
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| Veröffentlicht in: | Pediatric transplantation 2017-08, Vol.21 (5), p.n/a |
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| creator | Kaabak, Michael M. Babenko, Nadeen N. Shapiro, Ron Maschan, Alexey A. Zokoev, Allan K. Schekaturov, Stanislav V. Vyunkova, Julia N. Dymova, Olga V. |
| description | Recipient lymphocytes are crucial for direct and indirect pathways of allorecognition. We proposed that the administration of alemtuzumab several weeks pretransplantation could eradicate peripheral lymphatic cells and promote donor‐specific acceptance. This was a single‐center, retrospective review of 101 consecutive living donor kidney transplantations in pediatric patients (age 7 months—18 years), performed between September 2006 and April 2010. IS protocol included two 30 mg doses of alemtuzumab: The first was given 12‐29 days prior to transplantation, and the second at the time of transplantation. Maintenance IS was based on combination of low‐dose CNI and mycophenolate, with steroids tapered over the first 5 days post‐transplantation. Patients were followed for 7.8±1.3 years, and protocol biopsies were taken 1 month, 1, 3, and 5 years post‐transplant. The Kaplan‐Meier 8‐year patient and graft survival rates in the cyclosporine‐treated patients were 82.0±7.3% and 71.6±7.3, and in the tacrolimus‐treated patients were 97.2±5.4 and 83.8±6.0%. Biopsy‐proven acute rejection developed in 35% of cyclosporine‐treated patients and in 8% of tacrolimus‐treated patients. Alemtuzumab pretreatment prior to LRD kidney transplantation, followed by maintenance immunosuppression with tacrolimus and MMF, is associated with reasonable long‐term results in pediatric patients. |
| doi_str_mv | 10.1111/petr.12941 |
| format | Article |
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We proposed that the administration of alemtuzumab several weeks pretransplantation could eradicate peripheral lymphatic cells and promote donor‐specific acceptance. This was a single‐center, retrospective review of 101 consecutive living donor kidney transplantations in pediatric patients (age 7 months—18 years), performed between September 2006 and April 2010. IS protocol included two 30 mg doses of alemtuzumab: The first was given 12‐29 days prior to transplantation, and the second at the time of transplantation. Maintenance IS was based on combination of low‐dose CNI and mycophenolate, with steroids tapered over the first 5 days post‐transplantation. Patients were followed for 7.8±1.3 years, and protocol biopsies were taken 1 month, 1, 3, and 5 years post‐transplant. The Kaplan‐Meier 8‐year patient and graft survival rates in the cyclosporine‐treated patients were 82.0±7.3% and 71.6±7.3, and in the tacrolimus‐treated patients were 97.2±5.4 and 83.8±6.0%. Biopsy‐proven acute rejection developed in 35% of cyclosporine‐treated patients and in 8% of tacrolimus‐treated patients. Alemtuzumab pretreatment prior to LRD kidney transplantation, followed by maintenance immunosuppression with tacrolimus and MMF, is associated with reasonable long‐term results in pediatric patients.</description><identifier>ISSN: 1397-3142</identifier><identifier>EISSN: 1399-3046</identifier><identifier>DOI: 10.1111/petr.12941</identifier><identifier>PMID: 28600850</identifier><language>eng</language><publisher>Denmark: Wiley Subscription Services, Inc</publisher><subject>Adolescent ; Age ; Alemtuzumab - administration & dosage ; Alemtuzumab - therapeutic use ; alemtuzumab induction therapy ; Biopsy ; Child ; Child, Preschool ; Cyclosporins ; Drug Administration Schedule ; Female ; Follow-Up Studies ; Graft rejection ; Graft Rejection - diagnosis ; Graft Rejection - epidemiology ; Graft Rejection - prevention & control ; Graft Survival ; Humans ; Immunosuppression ; Immunosuppressive Agents - administration & dosage ; Immunosuppressive Agents - therapeutic use ; Immunotherapy ; Induction Chemotherapy - methods ; Infant ; Kidney transplantation ; Kidney Transplantation - methods ; live donor ; Living Donors ; long‐term results ; Lymphocytes ; Maintenance Chemotherapy - methods ; Male ; Monoclonal antibodies ; Mycophenolic acid ; pediatric kidney transplantation ; Pediatrics ; Perioperative Care - methods ; Retrospective Studies ; Steroid hormones ; steroid‐free immunosuppression ; Survival ; Tacrolimus ; Transplantation ; Transplants & implants ; Treatment Outcome</subject><ispartof>Pediatric transplantation, 2017-08, Vol.21 (5), p.n/a</ispartof><rights>2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd</rights><rights>2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3571-28ade175083f0a370b7467c927baf81239d417a3d5b0de39d97e00beac5cf0fa3</citedby><cites>FETCH-LOGICAL-c3571-28ade175083f0a370b7467c927baf81239d417a3d5b0de39d97e00beac5cf0fa3</cites><orcidid>0000-0001-7566-2330</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fpetr.12941$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fpetr.12941$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>315,781,785,1418,27929,27930,45579,45580</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28600850$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kaabak, Michael M.</creatorcontrib><creatorcontrib>Babenko, Nadeen N.</creatorcontrib><creatorcontrib>Shapiro, Ron</creatorcontrib><creatorcontrib>Maschan, Alexey A.</creatorcontrib><creatorcontrib>Zokoev, Allan K.</creatorcontrib><creatorcontrib>Schekaturov, Stanislav V.</creatorcontrib><creatorcontrib>Vyunkova, Julia N.</creatorcontrib><creatorcontrib>Dymova, Olga V.</creatorcontrib><title>Eight‐year follow‐up in pediatric living donor kidney recipients receiving alemtuzumab induction</title><title>Pediatric transplantation</title><addtitle>Pediatr Transplant</addtitle><description>Recipient lymphocytes are crucial for direct and indirect pathways of allorecognition. We proposed that the administration of alemtuzumab several weeks pretransplantation could eradicate peripheral lymphatic cells and promote donor‐specific acceptance. This was a single‐center, retrospective review of 101 consecutive living donor kidney transplantations in pediatric patients (age 7 months—18 years), performed between September 2006 and April 2010. IS protocol included two 30 mg doses of alemtuzumab: The first was given 12‐29 days prior to transplantation, and the second at the time of transplantation. Maintenance IS was based on combination of low‐dose CNI and mycophenolate, with steroids tapered over the first 5 days post‐transplantation. Patients were followed for 7.8±1.3 years, and protocol biopsies were taken 1 month, 1, 3, and 5 years post‐transplant. The Kaplan‐Meier 8‐year patient and graft survival rates in the cyclosporine‐treated patients were 82.0±7.3% and 71.6±7.3, and in the tacrolimus‐treated patients were 97.2±5.4 and 83.8±6.0%. Biopsy‐proven acute rejection developed in 35% of cyclosporine‐treated patients and in 8% of tacrolimus‐treated patients. Alemtuzumab pretreatment prior to LRD kidney transplantation, followed by maintenance immunosuppression with tacrolimus and MMF, is associated with reasonable long‐term results in pediatric patients.</description><subject>Adolescent</subject><subject>Age</subject><subject>Alemtuzumab - administration & dosage</subject><subject>Alemtuzumab - therapeutic use</subject><subject>alemtuzumab induction therapy</subject><subject>Biopsy</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Cyclosporins</subject><subject>Drug Administration Schedule</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Graft rejection</subject><subject>Graft Rejection - diagnosis</subject><subject>Graft Rejection - epidemiology</subject><subject>Graft Rejection - prevention & control</subject><subject>Graft Survival</subject><subject>Humans</subject><subject>Immunosuppression</subject><subject>Immunosuppressive Agents - administration & dosage</subject><subject>Immunosuppressive Agents - therapeutic use</subject><subject>Immunotherapy</subject><subject>Induction Chemotherapy - methods</subject><subject>Infant</subject><subject>Kidney transplantation</subject><subject>Kidney Transplantation - methods</subject><subject>live donor</subject><subject>Living Donors</subject><subject>long‐term results</subject><subject>Lymphocytes</subject><subject>Maintenance Chemotherapy - methods</subject><subject>Male</subject><subject>Monoclonal antibodies</subject><subject>Mycophenolic acid</subject><subject>pediatric kidney transplantation</subject><subject>Pediatrics</subject><subject>Perioperative Care - methods</subject><subject>Retrospective Studies</subject><subject>Steroid hormones</subject><subject>steroid‐free immunosuppression</subject><subject>Survival</subject><subject>Tacrolimus</subject><subject>Transplantation</subject><subject>Transplants & implants</subject><subject>Treatment Outcome</subject><issn>1397-3142</issn><issn>1399-3046</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp90M9KHTEUBvBQKtVqN30AGehGCmNP_sxNshS5tgVBKboeMskZGzszGZMZ5XbVR-gz9knMdayLLprNOQd-fISPkPcUjml-n0ac4jFlWtBXZI9yrUsOYvX6aZclp4Ltkrcp3QLQlVDiDdllagWgKtgjbu1vvk9_fv3eoIlFG7ouPORrHgs_FCM6b6bobdH5ez_cFC4MIRY_vBtwU0S0fvQ4TGm74iJMh_00_5x70-QEN9vJh-GA7LSmS_juee6T67P11emX8vzi89fTk_PS8krSkinjkMoKFG_BcAmNFCtpNZONaRVlXDtBpeGuasBhvrREgAaNrWwLreH75GjJHWO4mzFNde-Txa4zA4Y51VSDEkxTEJl--IfehjkO-XdZUaWAasay-rgoG0NKEdt6jL43cVNTqLfd19vu66fuMz58jpybHt0L_Vt2BnQBD77DzX-i6sv11bcl9BGKxpIf</recordid><startdate>201708</startdate><enddate>201708</enddate><creator>Kaabak, Michael M.</creator><creator>Babenko, Nadeen N.</creator><creator>Shapiro, Ron</creator><creator>Maschan, Alexey A.</creator><creator>Zokoev, Allan K.</creator><creator>Schekaturov, Stanislav V.</creator><creator>Vyunkova, Julia N.</creator><creator>Dymova, Olga V.</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>H94</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-7566-2330</orcidid></search><sort><creationdate>201708</creationdate><title>Eight‐year follow‐up in pediatric living donor kidney recipients receiving alemtuzumab induction</title><author>Kaabak, Michael M. ; Babenko, Nadeen N. ; Shapiro, Ron ; Maschan, Alexey A. ; Zokoev, Allan K. ; Schekaturov, Stanislav V. ; Vyunkova, Julia N. ; Dymova, Olga V.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3571-28ade175083f0a370b7467c927baf81239d417a3d5b0de39d97e00beac5cf0fa3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Adolescent</topic><topic>Age</topic><topic>Alemtuzumab - administration & dosage</topic><topic>Alemtuzumab - therapeutic use</topic><topic>alemtuzumab induction therapy</topic><topic>Biopsy</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Cyclosporins</topic><topic>Drug Administration Schedule</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Graft rejection</topic><topic>Graft Rejection - diagnosis</topic><topic>Graft Rejection - epidemiology</topic><topic>Graft Rejection - prevention & control</topic><topic>Graft Survival</topic><topic>Humans</topic><topic>Immunosuppression</topic><topic>Immunosuppressive Agents - administration & dosage</topic><topic>Immunosuppressive Agents - therapeutic use</topic><topic>Immunotherapy</topic><topic>Induction Chemotherapy - methods</topic><topic>Infant</topic><topic>Kidney transplantation</topic><topic>Kidney Transplantation - methods</topic><topic>live donor</topic><topic>Living Donors</topic><topic>long‐term results</topic><topic>Lymphocytes</topic><topic>Maintenance Chemotherapy - methods</topic><topic>Male</topic><topic>Monoclonal antibodies</topic><topic>Mycophenolic acid</topic><topic>pediatric kidney transplantation</topic><topic>Pediatrics</topic><topic>Perioperative Care - methods</topic><topic>Retrospective Studies</topic><topic>Steroid hormones</topic><topic>steroid‐free immunosuppression</topic><topic>Survival</topic><topic>Tacrolimus</topic><topic>Transplantation</topic><topic>Transplants & implants</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kaabak, Michael M.</creatorcontrib><creatorcontrib>Babenko, Nadeen N.</creatorcontrib><creatorcontrib>Shapiro, Ron</creatorcontrib><creatorcontrib>Maschan, Alexey A.</creatorcontrib><creatorcontrib>Zokoev, Allan K.</creatorcontrib><creatorcontrib>Schekaturov, Stanislav V.</creatorcontrib><creatorcontrib>Vyunkova, Julia N.</creatorcontrib><creatorcontrib>Dymova, Olga V.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Pediatric transplantation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kaabak, Michael M.</au><au>Babenko, Nadeen N.</au><au>Shapiro, Ron</au><au>Maschan, Alexey A.</au><au>Zokoev, Allan K.</au><au>Schekaturov, Stanislav V.</au><au>Vyunkova, Julia N.</au><au>Dymova, Olga V.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Eight‐year follow‐up in pediatric living donor kidney recipients receiving alemtuzumab induction</atitle><jtitle>Pediatric transplantation</jtitle><addtitle>Pediatr Transplant</addtitle><date>2017-08</date><risdate>2017</risdate><volume>21</volume><issue>5</issue><epage>n/a</epage><issn>1397-3142</issn><eissn>1399-3046</eissn><abstract>Recipient lymphocytes are crucial for direct and indirect pathways of allorecognition. We proposed that the administration of alemtuzumab several weeks pretransplantation could eradicate peripheral lymphatic cells and promote donor‐specific acceptance. This was a single‐center, retrospective review of 101 consecutive living donor kidney transplantations in pediatric patients (age 7 months—18 years), performed between September 2006 and April 2010. IS protocol included two 30 mg doses of alemtuzumab: The first was given 12‐29 days prior to transplantation, and the second at the time of transplantation. Maintenance IS was based on combination of low‐dose CNI and mycophenolate, with steroids tapered over the first 5 days post‐transplantation. Patients were followed for 7.8±1.3 years, and protocol biopsies were taken 1 month, 1, 3, and 5 years post‐transplant. The Kaplan‐Meier 8‐year patient and graft survival rates in the cyclosporine‐treated patients were 82.0±7.3% and 71.6±7.3, and in the tacrolimus‐treated patients were 97.2±5.4 and 83.8±6.0%. Biopsy‐proven acute rejection developed in 35% of cyclosporine‐treated patients and in 8% of tacrolimus‐treated patients. Alemtuzumab pretreatment prior to LRD kidney transplantation, followed by maintenance immunosuppression with tacrolimus and MMF, is associated with reasonable long‐term results in pediatric patients.</abstract><cop>Denmark</cop><pub>Wiley Subscription Services, Inc</pub><pmid>28600850</pmid><doi>10.1111/petr.12941</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0001-7566-2330</orcidid></addata></record> |
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| source | Wiley Online Library - AutoHoldings Journals; MEDLINE |
| subjects | Adolescent Age Alemtuzumab - administration & dosage Alemtuzumab - therapeutic use alemtuzumab induction therapy Biopsy Child Child, Preschool Cyclosporins Drug Administration Schedule Female Follow-Up Studies Graft rejection Graft Rejection - diagnosis Graft Rejection - epidemiology Graft Rejection - prevention & control Graft Survival Humans Immunosuppression Immunosuppressive Agents - administration & dosage Immunosuppressive Agents - therapeutic use Immunotherapy Induction Chemotherapy - methods Infant Kidney transplantation Kidney Transplantation - methods live donor Living Donors long‐term results Lymphocytes Maintenance Chemotherapy - methods Male Monoclonal antibodies Mycophenolic acid pediatric kidney transplantation Pediatrics Perioperative Care - methods Retrospective Studies Steroid hormones steroid‐free immunosuppression Survival Tacrolimus Transplantation Transplants & implants Treatment Outcome |
| title | Eight‐year follow‐up in pediatric living donor kidney recipients receiving alemtuzumab induction |
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