Introduction: Experience with alemtuzumab (alem) depleting antibody induction has rarely been studied in the pediatric population, and reports that exist have limited follow-up. The purpose of this study is to compare the efficacy of alem and rabbit anti-thymocyte globulin (rATG) as induction agents in pediatric kidney transplantation. Methods: We conducted a retrospective single-center chart review, assessing patient and graft survival, rates of biopsy proven rejection, and development of any malignancy during follow-up in pediatric kidney recipients who received depleting antibody induction therapy. Alem was given as a single 10-30mg dose during transplant (tx). rATG (1.5 mg/kg) was started during tx, then given for a total of 3-5 doses on alternate days after tx. Patient age, ethnicity, and type of transplant (deceased or living donor) were compared between the alem and rATG groups. Results: From February 2003 to December 2013, 76 pediatric patients underwent kidney tx and received alem (n=41) or rATG (n=35) as induction therapy. There were no significant differences in age (range 1-21 yrs; mean 12.9±6.1 yrs), race (29% African American) or donor type (34% living donors) between groups. Mean follow-up for the entire cohort was 98±36 months. Patient survival at 5 and 8 yrs follow-up was 95 and 88% in the alem group and 91 and 89% in the rATG group, respectively (NS). Graft survival at 5 and 8 yrs follow-up was 78 and 67% in the alem group and 69 and 60% in the rATG group, respectively (NS). 12% in the alem group and 18% in the rATG group had biopsy proven rejection in the 1^st year, with 80% free of rejection at 8 years in the alem group versus 54% in the rATG group (p=0.017). Malignancy occurred in 6 patients (8%); 5 post-transplant lymphomas (PTLDs) and 1 incidence of cervical cancer at a mean follow-up of 55±43 months. 3 cases (9%) of PTLD occurred in the rATG group, while 2 cases (5%) of PTLD and the lone case of cervical cancer occurred in the alem group (NS). Conclusion: Multiple dose rATG and single dose alem induction immunotherapy are associated with similar and acceptable patient and graft survival in longer-term follow-up after pediatric kidney tx. Alem, as compared to rATG, may lower the rate of kidney graft rejection in pediatric patients, however rates of post-transplant malignancy appear similar.

CITATION INFORMATION: Harriman D., Chen A., Rogers J., Stratta R., Orlando G., South A., Lin J-.J., Farney A. Long-Term Follow-Up of Pediatric Kidney Recipients Who Received Alemtuzumab Induction Am J Transplant. 2017;17 (suppl 3).

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