Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Aug;25(5):e13925.
doi: 10.1111/petr.13925. Epub 2020 Dec 17.

Primary pediatric live-donor-kidney transplant-recipients' outcomes by immunosuppression induction received in the United States

Samy Riad  1 , Scott Jackson  2 , Srinath Chinnakotla  3 , Priya Verghese  4   5
Affiliations

Primary pediatric live-donor-kidney transplant-recipients' outcomes by immunosuppression induction received in the United States

Samy Riad et al. Pediatr Transplant. 2021 Aug.

Abstract

Objective: We examined the association between induction type and outcomes of live-donor pediatric kidney recipients on tacrolimus and mycophenolate maintenance.

Material and methods: We analyzed the SRTR standard analysis file to evaluate primary live-donor pediatric kidney recipients between 2000 and 2018. Recipients were grouped by induction type into three groups: alemtuzumab n = 289, anti-thymocyte n = 1197, and IL-2RA n = 1625. Kaplan-Meier curves were generated for recipient and death-censored graft survival. Predictors of recipient and allograft survival were examined using Cox proportional hazards models. Models were adjusted for age, sex, ethnicity, renal failure etiology, HLA-mismatches, transplant year, steroid maintenance, preemptive transplantation, payor type, and donor factors such as age, sex, and donor-recipient relationship. The transplant center was included as a random effect to account for inter-center variability.

Results: Rejection rates at 6 months (Alemtuzumab 9.5% vs. r-ATG 5.7% vs. IL2-RA 5.3%; P: .023) and 12 months (Alemtuzumab 14.5% vs. r-ATG 10.8% vs. IL2-RA 9%; P: .028) were significantly higher in the alemtuzumab group. PTLD rate (Alemtuzumab 0.8% vs. r-ATG 2.2% vs. IL2-RA 1%; P: .028) was significantly higher in the anti-thymocyte group. In the multivariable models, induction type did not influence patient or death-censored graft survival within ten years post-transplant.

Conclusion: In this large cohort of standard immunological risk primary pediatric live-donor kidney recipients, as compared to IL-2RA, neither alemtuzumab nor anti-thymocyte globulin was associated with improved long-term graft or recipient survival. In the first year post-transplant, recipients of alemtuzumab induction had a higher rejection rate, while PTLD was more frequently observed in the anti-thymocyte recipients.

Keywords: induction; kidney transplant; living Donor; pediatric.

PubMed Disclaimer

References

REFERENCES

    1. Sampaio MS, Poommipanit N, Kuo HT, et al. Induction therapy in pediatric kidney transplant recipients discharged with a triple drug immunosuppressive regimen. Pediatr Transplant. 2010;14(6):770-778.
    1. Hart A, Smith JM, Skeans MA, et al. OPTN/SRTR 2017 annual data report: kidney. Am J Transplant. 2019;19(Suppl 2):19-123.
    1. Mincham CM, Wong G, Teixeira-Pinto A, et al. Induction therapy, rejection, and graft outcomes in pediatric and adolescent kidney transplant recipients. Transplantation. 2017;101(9):2146-2151.
    1. Horslen S, Barr ML, Christensen LL, Ettenger R, Magee JC. Pediatric transplantation in the United States, 1996-2005. Am J Transplant. 2007;7(5 Pt 2):1339-1358.
    1. Mourani C, Moukarzel M, Gerbaka B, Nehme Chelala D, Azar H. Kidney transplantation in pediatric patients: 18-year experience at Hotel-Dieu de France. J Med Liban. 2015;63(3):116-121.