title: Pediatric living donor kidney transplantation under alemtuzumab pretreatment and tacrolimus monotherapy: 4-year experience.
abstract: BACKGROUND
  Alemtuzumab has been used in off-label studies of solid organ transplantation.
  
  
  METHODS
  We analyzed the first 42 pediatric consecutive living donor kidney transplantations under alemtuzumab pretreatment with tacrolimus monotherapy and subsequent spaced weaning. We focused especially on the causes of recipient death and graft loss and the characteristics of rejection.
  
  
  RESULTS
  Laparoscopic live-donor nephrectomy was associated with no mortality and no delayed graft function. The actuarial 1, 2, 3, and 4 years patient and graft survivals were 97.6% and 97.6%, 93.5% and 85.4%, 93.5% and 85.4%, and 93.5% and 85.4%, respectively. The incidence of cumulative acute cellular rejection (ACR) at 1, 2, 3, and 4 years was 0%, 2.4%, 4.8%, and 4.8%, respectively. The mean serum creatinine (mg/dL) and glomerular filtration rate (mL/min/1.73 m) at 1, 2, and 3 years were 0.8+/-0.4 and 94.0+/-36.8, 0.9+/-0.4 and 79.6+/-31.9, and 0.9+/-0.4 and 95.0+/-21.7, respectively. Two (4.7%) recipients had ACR, and both Banff 1a ACRs were steroid sensitive. No patients had antibody-mediated rejection. Weaning to spaced dose (qod or less) tacrolimus monotherapy was attempted in 16 (38%) and was successful in 12 (26%) patients. All patients are currently steroid free. There was no tissue invasive cytomegalovirus disease or infection, no BK/polyoma viral nephropathy, and no posttransplant proliferative disease.
  
  
  CONCLUSIONS
  This experience confirms the 4-year safety and efficacy of this approach in pediatric recipients.
authors.affiliation: The Thomas E Starzl Transplantation Institute, University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Pittsburgh, PA 15213, USA. tanhp@upmc.edu
authors.forename: Henkie P
authors.initials: HP
authors.lastname: Tan
authors.forename: Joseph
authors.initials: J
authors.lastname: Donaldson
authors.forename: Demetrius
authors.initials: D
authors.lastname: Ellis
authors.forename: Michael L
authors.initials: ML
authors.lastname: Moritz
authors.forename: Amit
authors.initials: A
authors.lastname: Basu
authors.forename: Claire
authors.initials: C
authors.lastname: Morgan
authors.forename: Abhay N
authors.initials: AN
authors.lastname: Vats
authors.forename: Elif
authors.initials: E
authors.lastname: Erkan
authors.forename: Ron
authors.initials: R
authors.lastname: Shapiro
mesh_terms: D000328:Adult; D000074323:Alemtuzumab; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm / Q000627:therapeutic use*; D002648:Child; D003404:Creatinine / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000453:epidemiology; D006650:Histocompatibility Testing; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007674:Kidney Diseases / Q000145:classification / Q000601:surgery; D016030:Kidney Transplantation / Q000276:immunology* / Q000401:mortality; D019520:Living Donors; D008297:Male; D012086:Reoperation / Q000706:statistics & numerical data; D016019:Survival Analysis; D016559:Tacrolimus / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm; D007166:Immunosuppressive Agents; D000074323:Alemtuzumab; D003404:Creatinine; D016559:Tacrolimus