Link to the University of Pittsburgh Homepage
Link to the University Library System Homepage Link to the Contact Us Form

Renal transplantation in children managed with lymphocyte depleting agents and low-dose maintenance tacrolimus monotherapy

Ellis, D and Shapiro, R and Moritz, M and Vats, A and Basu, A and Tan, H and Kayler, L and Janosky, J and Starzl, TE (2007) Renal transplantation in children managed with lymphocyte depleting agents and low-dose maintenance tacrolimus monotherapy. Transplantation, 83 (12). 1563 - 1570. ISSN 0041-1337

[img]
Preview
PDF
Accepted Version
Available under License : See the attached license file.

Download (676kB) | Preview
[img] Plain Text (licence)
Available under License : See the attached license file.

Download (1kB)

Abstract

OBJECTIVE. Describe the safety and efficacy of antithymocyte globulin or alemtuzumab preconditioning, steroid avoidance and reduced calcineurin inhibitor (CNI) immunosuppression in 34 children undergoing renal transplantation. METHODS. ATG (n=8) or alemtuzumab (n=26) were infused at the time of transplantation. This was followed by low-dose twice a day tacrolimus monotherapy with consolidation to once daily dosing by 6 months and once every other day dosing by 12 months. Follow-up ranged from 0.5-2.9 years (mean 1.33 years), with a minimum of 6 months. RESULTS. Both ATG and alemtuzumab were well tolerated. Lymphopenia occurred routinely and resol ved after 3-6 months. Acute cellular rejection occurred in 9%; it was related to medical nonadherence in two patients and resulted in one graft loss at 1.5 years. Important adverse events included transient neutropenia in 10 children (none with serious infection), and autoimmune hemolytic anemia in two (resolved with a steroid course in both and conversion to sirolimus in one). Estimated glomerular filtration rate (e-GFR) was stable and averaged 88 mL/min/1.73 m at latest follow-up. Fifteen preadolescents had a greater increase in height Z-score at 1 year (1.3 vs. 0.5, P=0.001), and a higher e-GFR (94.8±21 vs. 76.6±20 ml/min/1.73 m, P < 0.05), when compared to case-matched historical controls who were weaned off steroids by 6 months after transplantation and received twice daily tacrolimus monotherapy. CONCLUSION. This simple regimen appears safe, has a low risk for acute cellular rejection or other adverse effects, and is associated with excellent growth and renal function. Such a regimen may also improve compliance and limit CNI nephrotoxicity. © 2007 Lippincott Williams & Wilkins, Inc.


Share

Citation/Export:
Social Networking:
Share |

Details

Item Type: Article
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Ellis, D
Shapiro, R
Moritz, M
Vats, A
Basu, A
Tan, H
Kayler, L
Janosky, J
Starzl, TEtes11@pitt.eduTES11
Centers: Other Centers, Institutes, or Units > Thomas E. Starzl Transplantation Institute
Date: 1 June 2007
Date Type: Publication
Journal or Publication Title: Transplantation
Volume: 83
Number: 12
Page Range: 1563 - 1570
DOI or Unique Handle: 10.1097/01.tp.0000266576.01935.ea
Institution: University of Pittsburgh
Refereed: Yes
ISSN: 0041-1337
Other ID: uls-drl:31735062121524, Starzl CV No. 2240
Date Deposited: 08 Apr 2010 17:38
Last Modified: 13 Oct 2017 22:56
URI: http://d-scholarship.pitt.edu/id/eprint/5626

Metrics

Monthly Views for the past 3 years

Plum Analytics

Altmetric.com


Actions (login required)

View Item View Item