Alemtuzumab induction with tacrolimus monotherapy in 25 pediatric renal transplant recipients

ALA induction in transplantation has been shown to reduce the need for maintenance immunosuppression. We report the outcome of 25 pediatric renal transplants between 2007 and 2010 using ALA induction followed by tacrolimus maintenance monotherapy. Patient ages were 1-19yr (mean 14 +/- 4.1yr). Time of follow-up was 7-51months (mean 26 +/- 13months). Tacrolimus monotherapy was maintained in 48% of patients, and glucocorticoids were avoided in 80% of recipients. Mean plasma creatinine and GFR at oneyr post-transplant were 0.88 +/- 0.3mg/dL and 104.4 +/- 25mL/min/1.73m(2), respectively. One, two, and three-yr actuarial patient and graft survival rates were 100%. The incidence of early AR (<12months after transplantation) was 12%, while the incidence of late AR (after 12months) was 16%. Forty-four percent of the recipients recovered normal, baseline renal function after an episode of AR, and 44% had persistent renal dysfunction (plasma creatinine 1.0-1.8mg/dL). One graft was lost fouryr after transplantation due to medication non-compliance. Four (16%) patients developed BK or CMV infection. In our experience, ALA induction with tacrolimus monotherapy resulted in excellent short- and mid-term patient and graft survival in low-immunologic risk pediatric renal transplant recipients.