Introduction:

Early steroid withdrawal (SW) for maintenance immunosuppression has been gaining acceptance in pediatric kidney transplant recipients. Despite its use in adult renal transplants, data on long term outcomes of thymoglobulin induction in the pediatric population has not been well described. Early steroid withdrawal with thymoglobulin induction has been adopted in the majority of adult transplant recipients at our institution. We report our single center experience using thymoglobulin as standard induction therapy in pediatric kidney transplants.

Methods:

Thirty-six pediatric patients (mean age 11.6 ± 5 years), who underwent renal transplants between June 2003 and November 2011, received thymoglobulin induction and early SW with tacrolimus and mycophenolate mofetil as maintenance immunosuppression. Renal allograft function was examined and multivariate analysis was performed at one, three and five years post-transplant. Analysis was performed based on age, gender, race, donor type (living vs. deceased), and number of previous transplants.

Results:

Patient survival was 100% throughout the follow-up period in this cohort, with a mean follow-up period of 3.2 ± 1.6 years. Graft survival was 100%, 97%, and 94% at one, three, and five years post-transplant, respectively. Five episodes of rejection were treated in five different recipients during this time span, but only one (2.7%) in the first year. Two episodes were biopsy proven and three were based on a history of non-compliance. Treated infection episodes (e.g. viral, urine, and respiratory) at one, three, and five years were 8.3%, 22.2% and 27.7%, respectively. Creatinine clearance, as calculated by the Schwartz formula, was 77.3 ± 24.1, 63.6 ± 15.8, and 60.9 ± 14.5 mL/min/1.73 m², respectively. Multivariate analysis at one year demonstrated a 28% lower GFR in African American recipients (p=0.04) as well as a 15.5% lower GFR in recipients over the age of 12 (p=0.05), but there was no difference in outcomes as it relates to age, gender, race, living vs. deceased donor, or re-transplants.

Conclusion:

Thymoglobulin induction appears to be safe and effective when used in the setting of an early SW protocol with respect to patient and graft survival, without any increased risk of infection or rejection. Lower baseline renal function at one year was noted in African American recipients and those over the age of 12, although the clinical significance of this is unclear.

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