Introduction: Recipient parenchymal lymphatic cells are crucial for direct and indirect pathways of allorecognition. We proposed that administering alemtuzumab several weeks pretransplantation could eradicate peripheral lymphatic cells and promote donor-specific acceptance.

Method: This was a single center, retrospective review of 101 consecutive living-donor kidney transplantations in pediatric patients age seven month to 18 years, performed between September 2006 and April 2010.

Immunosuppression (IS) protocol included two 30 mg doses of alemtuzumab, the first dose administered 12–29 days prior to transplantation and second at the time of transplantation. Maintenance IS was based on combination of a CNI and mycophenolate. Maintenance steroids were tapered off in 96% of patients 7±6[middot]4 days after transplantation. Patients were followed for 7[middot]2±1[middot]0 years, and 412 protocol biopsies were taken one month, and one, three, and five years post transplant.

The choice of CNI (cyclosporine or tacrolimus) was initially dependent on drug availability; beginning in April 2009, we began a randomized trial of cyclosporine vs. tacrolimus (clinicaltrials.gov identifier: NCT01346397). The trough levels of tacrolimus were adjusted to 2-8 ng/ml starting from day 11. The levels of cyclosporine were measured as a 12 hour trough and at one and three hours after administration of the dose and adjusted for the target area under the curve (AUC) 1500-2000 ng/ml/hours and C0 50-100 from day 31.

Results: The 7 year Kaplan-Meier graft survival and graft function was statistically significantly better in tacrolimus group. There were trend to better patient survival and lower blood pressure and proteinuria in tacrolimus group (table).

Conclusion: Alemtuzumab pretreatment prior to LRD kidney transplantation, followed by maintenance immunosuppression with tacrolimus and MMF, is associated with reasonable long-term results in pediatric patients.

CITATION INFORMATION: Kaabak M, Babenko N, Zokoyev A, Shapiro R. After Alemtuzumab Induction, Tac+MMF Is Superior to CsA+MMF in Pediatric Kidney Transplantation. Am J Transplant. 2016;16 (suppl 3).

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