*Purpose: Induction therapy is a standard component of kidney transplant immunosuppression protocols. However, in the pediatric population, there are still uncertainties about the ideal induction therapy to achieve the lowest rate of acute rejection with low incidence of infections and malignancy.

*Methods: This single-center, natural experiment compares one year efficacy and safety of a single 3mg/Kg dose of rabbit anti-thymocyte globulin (rATG) versus Basiliximab (BAS) in all consecutive pediatric kidney transplant recipients. BAS was used from May 2013 until April 2016, switched to rATG from May 2016 to April 2018. All patients received a calcineurin inhibitor, azathioprine or mycophenolic acid, and prednisone as maintenance therapy. No pharmacological prophylaxis against CMV was used. Exclusion criteria were PRA > 50%, re-transplants, use of investigational drug and those who lost follow-up in the first year after transplantation.

*Results: Of 266 pediatric kidney transplants during this period, 227 patients (85%) were included for analysis (rATG, n=114; BAS, n=114). The incidence of first biopsy-proven acute rejection (18 vs. 32%, p=0.002) and first treated acute rejection (19 vs. 34%, p=0.01) was lower in the rATG group. There was no difference in the overall incidence of CMV infection/disease (33 vs. 37% p=0.5), but a lower rate of CMV infection/disease after treatment of acute rejection episodes (6% vs. 14%, p=0.04) in the rATG group. Patients in the rATG group showed lower rate of EBV-infection (1 vs. 7%, p=0.02), and similar incidence of PTLD (1 vs. 3%, p=0.28). Mean creatinine at the end of the first year was similar in both groups (1,07±0,4 vs. 1,05±0,4).There was no difference in one-year patient (100 vs. 98%) and graft (97 vs. 94%) survivals.

*Conclusions: Compared to BAS, a single 3mg/Kg rATG induction therapy is associated with improved efficacy without compromising the safety of the immunosuppressive regimen in low-risk pediatric kidney transplants.

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