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Antilymphoid antibody preconditioning and tacrolimus monotherapy for pediatric kidney transplantation

Shapiro, R and Ellis, D and Tan, HP and Moritz, ML and Basu, A and Vats, AN and Khan, AS and Gray, EA and Zeevi, A and McFeaters, C and James, G and Jo Grosso, M and Marcos, A and Starzl, TE (2006) Antilymphoid antibody preconditioning and tacrolimus monotherapy for pediatric kidney transplantation. Journal of Pediatrics, 148 (6). 813 - 818. ISSN 0022-3476

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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. Study design: 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 m 2 . 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. Conclusion: The strategy of lymphoid depletion and minimum post-transplant immunosuppression appears safe and effective for pediatric kidney recipients. © 2006 Elsevier Inc. All rights reserved.


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Details

Item Type: Article
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Shapiro, R
Ellis, D
Tan, HP
Moritz, ML
Basu, A
Vats, AN
Khan, AS
Gray, EA
Zeevi, A
McFeaters, C
James, G
Jo Grosso, M
Marcos, A
Starzl, TEtes11@pitt.eduTES11
Centers: Other Centers, Institutes, or Units > Thomas E. Starzl Transplantation Institute
Date: 1 June 2006
Date Type: Publication
Journal or Publication Title: Journal of Pediatrics
Volume: 148
Number: 6
Page Range: 813 - 818
DOI or Unique Handle: 10.1016/j.jpeds.2006.01.008
Institution: University of Pittsburgh
Refereed: Yes
ISSN: 0022-3476
Other ID: uls-drl:31735062121268, Starzl CV No. 2218
Date Deposited: 08 Apr 2010 17:38
Last Modified: 13 Oct 2017 22:56
URI: http://d-scholarship.pitt.edu/id/eprint/5604

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