title: Antilymphoid antibody preconditioning and tacrolimus monotherapy for pediatric kidney transplantation.
abstract: OBJECTIVE
  Heavy post-transplant immunosuppression may contribute to long-term immunosuppression dependence by subverting tolerogenic mechanisms; thus, we sought to determine if this undesirable consequence could be mitigated by pretransplant lymphoid depletion and minimalistic post-transplant monotherapy.
  
  
  METHODS
  Lymphoid depletion in 17 unselected pediatric recipients of live (n = 14) or deceased donor kidneys (n = 3) was accomplished with antithymocyte globulin (ATG) (n = 8) or alemtuzumab (n = 9). Tacrolimus was begun post-transplantation with subsequent lengthening of intervals between doses (spaced weaning). Maintenance immunosuppression, morbidity, graft function, and patient/graft survival were collated.
  
  
  RESULTS
  Steroids were added temporarily to treat rejection in two patients (both ATG subgroup) or to treat hemolytic anemia in two others. After 16 to 31 months (mean 22), patient and graft survival was 100% and 94%, respectively. The only graft loss was in a nonweaned noncompliant recipient. In the other 16, serum creatinine was 0.85 +/- 0.35 mg/dL and creatinine clearance was 90.8 +/- 22.1 mL/1.73 m2. All 16 patients are on monotherapy (15 tacrolimus, one sirolimus), and 14 receive every other day or 3 times per week doses. There were no wound or other infections. Two patients developed insulin-dependent diabetes.
  
  
  CONCLUSIONS
  The strategy of lymphoid depletion and minimum post-transplant immunosuppression appears safe and effective for pediatric kidney recipients.
authors.affiliation: Thomas E. Starzl Transplantation Institute, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA.
authors.forename: Ron
authors.initials: R
authors.lastname: Shapiro
authors.forename: Demetrius
authors.initials: D
authors.lastname: Ellis
authors.forename: Henkie P
authors.initials: HP
authors.lastname: Tan
authors.forename: Michael L
authors.initials: ML
authors.lastname: Moritz
authors.forename: Amit
authors.initials: A
authors.lastname: Basu
authors.forename: Abhay N
authors.initials: AN
authors.lastname: Vats
authors.forename: Akhtar S
authors.initials: AS
authors.lastname: Khan
authors.forename: Edward A
authors.initials: EA
authors.lastname: Gray
authors.forename: Adrianna
authors.initials: A
authors.lastname: Zeevi
authors.forename: Corde
authors.initials: C
authors.lastname: McFeaters
authors.forename: Gerri
authors.initials: G
authors.lastname: James
authors.forename: Mary
authors.initials: M
authors.lastname: Jo Grosso
authors.forename: Amadeo
authors.initials: A
authors.lastname: Marcos
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Starzl
mesh_terms: D000293:Adolescent; D000074323:Alemtuzumab; D019072:Antibiotic Prophylaxis; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm / Q000008:administration & dosage / Q000627:therapeutic use; D000961:Antilymphocyte Serum / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003404:Creatinine / Q000097:blood; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D007223:Infant; D016030:Kidney Transplantation / Q000276:immunology*; D020123:Sirolimus / Q000008:administration & dosage / Q000627:therapeutic use; D016019:Survival Analysis; D013601:T-Lymphocytes / Q000187:drug effects / Q000276:immunology*; D016559:Tacrolimus / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm; D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents; D000074323:Alemtuzumab; D003404:Creatinine; D020123:Sirolimus; D016559:Tacrolimus