INTRODUCTION AND OBJECTIVES: Alemtuzumab (Campath-1H, C1H) is a monoclonal antibody targeting CD52 receptors on B- and T-lymphocytes and is an effective induction agent in renal transplantation. We report a seven-year experience using C1H induction and steroid-free protocol in the pediatric population as safe and effective.

METHODS: Between 2006 and 2012, 21 pediatric deceased-donor renal transplants were performed at a single academic center. Mean recipient age was 14.3 years (range 4 – 18). Six of the 21 recipients were African-American, 8 were Hispanic, 7 were Caucasian, 14 were male, and 3 were re-transplants. All 21 pediatric recipients received a single intraoperative dose of alemtuzumab (0.6 mg/kg, range 10-30 mg), 3 doses of IV methylprednisolone, tacrolimus (TAC), and low-dose mycophenolate mofetil (MMF). Immunosuppression was maintained using TAC and MMF.

RESULTS: The average follow-up period was 32 months. All patients had immediate graft function. Graft survival was 95% and patient survival was 100%. Mean 12- and 36-month eGFR were 60.3±28.9 and 56.4±14.4 mL/min/1.73m2, respectively. Two patients developed acute T-cell mediated rejection on average 10.5 months from transplantation (See Figure). One was treated successfully. The other one had a transplant nephrectomy at 20 months for graft failure believed to be secondary to the patient’s persistent non-compliance with the immunosuppression regimen. No pediatric recipients developed cytomegalovirus (CMV) infection, post-transplant lymphoproliferative disease (PTLD) or Polyoma BK viral nephropathy. No cases of post-transplant diabetes mellitus (PTDM) or hyperlipidemia have been seen in this group. All 21 patients stayed on TAC and low-dose MMF throughout their post-transplant course.

CONCLUSIONS: Steroid-free immunosuppression with single dose C1H induction provides adequate and safe immunosuppression in pediatric deceased-donor renal transplant recipients receiving TAC and low-dose MMF maintenance therapy. These results compare favorably with our adult renal transplant experience. The authors plan to continue their current steroid-free protocol in existing and future patients.

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