Use of antibody induction in pediatric renal transplantation.
OBJECTIVE
The present review provides an update on the recent literature documenting the use of antibody induction in pediatric transplantation.


RESULTS
The use of antibody induction has been increasing as it has been considered to be an important component of steroid-avoidance protocols following pediatric renal transplantation. According to registry data, anti-interleukin-2R monoclonal antibodies are the predominant agents being used, with slightly more patients receiving basiliximab than daclizumab. Using antibody induction, steroid avoidance is possible while maintaining rejection rates of less than 10%. Preliminary data are appearing, in which both steroid elimination and calcineurin reduction are possible. Concerns, however, are being raised about the risk of overimmunosuppression, in particular increased rates of polyoma virus and lymphoma.


CONCLUSIONS
Antibody induction is firmly entrenched within the pediatric renal transplant community. There is an ongoing evolution of the types of antibodies being used. The ultimate answer for efficacy and safety will require larger samples and prospective studies.
Pescovitz
Mark D
MD
Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA. mpescov@iupui.edu
D000293:Adolescent; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D058846:Antibodies, Monoclonal, Murine-Derived; D000961:Antilymphocyte Serum / Q000009:adverse effects / Q000627:therapeutic use*; D001402:B-Lymphocytes / Q000187:drug effects / Q000276:immunology; D000077552:Basiliximab; D002648:Child; D002675:Child, Preschool; D000077561:Daclizumab; D006801:Humans; D007074:Immunoglobulin G / Q000627:therapeutic use; D007165:Immunosuppression Therapy / Q000009:adverse effects / Q000379:methods*; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016030:Kidney Transplantation; D011993:Recombinant Fusion Proteins / Q000627:therapeutic use; D000069283:Rituximab; D013256:Steroids / Q000009:adverse effects; D013601:T-Lymphocytes / Q000187:drug effects / Q000276:immunology
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D058846:Antibodies, Monoclonal, Murine-Derived; D000961:Antilymphocyte Serum; D007074:Immunoglobulin G; D007166:Immunosuppressive Agents; D011993:Recombinant Fusion Proteins; D013256:Steroids; D000069283:Rituximab; D000077552:Basiliximab; D000077561:Daclizumab