Purpose: We report the outcomes from single center experience with the novel induction regimen using rATG (3 mg/kg) in divided doses given on operative day zero and post-operative day one and basiliximab (20 mg) given on day two, followed by steroid-free maintenance therapy for pediatric patients undergoing kidney transplantation.

Methods: We retrospectively reviewed 208 consecutive patients who underwent kidney transplantation from 1/1/2009 to 10/1/2014 at our institution. Patients identified as younger than 18 years old at the time of transplantation were included for comparison. 6 patients were identified in the current rATG plus basiliximab group (Cohort A), and 15 in the historical basiliximab with steroid taper group (Cohort B). Outcomes between the two groups were compared using hospital length of stay, mean GFR at timepoints 0 and 1 month, infectious complications, readmissions, biopsy proven rejection episodes, graft failure, and death, for a period of up to 1 year.

Results: The average age for patients in cohorts A and B were 16.4 and 12.5, respectively. 0 patients in cohort A were identified as high risk, as defined by a peak panel reactive antibody of greater than or equal to 20% or previous transplantation, while 3 patients in cohort B were identified as such. The hospital length of stay was 8.5 days versus 7.1 days between cohorts A and B. Mean GFR at the time of transplantation was 7 and 10 ml/min/1.73m2, compared to mean GFRs of 77 and 98ml/min/1.73m2 between cohorts A and B, respectively. Infectious complications occurred in 1/6 (16.7%) vs. 8/15 (53.3%) patients, and readmissions in 1/6 (16.7%) vs. 10/15(66.7%). Rejection episodes occurred in 0/6 (0%) and 2/15 (13.3%) patients. There were no episodes of graft failure or death in either group within one year.

Conclusions: Our preliminary experience using an induction regimen of rATG plus basiliximab in a pediatric patient population undergoing kidney transplantation suggests that the combination may be both safe and effective, although additional, larger studies with longer follow up is warranted.

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