Frontiers in pediatrics · 2026
Retrospective comparison of two distinct dual-induction strategies in pediatric kidney transplantation: three doses vs. a single dose of rabbit antithymocyte globulin, each combined with two basiliximab doses.
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Ciancio Gaetano, Gaynor Jeffrey J, Morsi Mahmoud, Alvarez Angel, Gaynor Matthew, Defreitas Marissa, Chandar Jayanthi
Аннотация
BACKGROUND: We retrospectively compared two distinct dual-induction strategies in pediatric kidney transplantation.
METHODS: Patients transplanted at our center prior to 15 February 2020 were scheduled to receive three doses of rabbit antithymocyte globulin (rATG; 1.0 mg/kg/dose) along with two doses of basiliximab (N = 42), while patients transplanted thereafter were scheduled to receive a single dose of rATG with two doses of basiliximab (N = 50). Both intent-to-treat (ITT) groups were scheduled to receive reduced tacrolimus dosing, mycophenolate acid, and early corticosteroid withdrawal. The two primary endpoints were first biopsy-proven acute rejection (BPAR) and any viral viremia. In allowing for a similar follow-up period, all clinical outcomes were compared during the first 24 months (mo) post-transplant. In addition, multivariable analyses were performed adjusting for the propensity to belong to the single-dose ITT rATG group.
RESULTS: Median follow-up in both groups was 24 mo post-transplant. In the single-dose ITT rATG group, a higher proportion of patients developed a first BPAR [P = 0.10; 34.0% (17/50) vs. 21.4% (9/42)], while a lower proportion developed any viral viremia [P = 0.08; 28.0% (14/50) vs. 47.6% (20/42)]. Two baseline variables were associated with a significantly higher propensity to belong to the single-dose ITT rATG group: older recipient age (P = 0.02) and longer WIT (P = 0.02). After adjusting for the propensity score in multivariable analyses, the single-dose ITT rATG group remained associated with a higher first BPAR rate (P = 0.06) but was no longer associated with the rate of viral viremia (P = 0.30). Estimated graft survival at 24 mo post-transplant (combined across both groups) was 92.9% ± 2.8%.
CONCLUSIONS: A lower rate of first BPAR but a somewhat higher rate of viral infection was observed in the three-dose ITT rATG group. These study results support the use of tailored induction protocols to optimize effective immunosuppression while minimizing adverse effects in pediatric kidney transplantation.
METHODS: Patients transplanted at our center prior to 15 February 2020 were scheduled to receive three doses of rabbit antithymocyte globulin (rATG; 1.0 mg/kg/dose) along with two doses of basiliximab (N = 42), while patients transplanted thereafter were scheduled to receive a single dose of rATG with two doses of basiliximab (N = 50). Both intent-to-treat (ITT) groups were scheduled to receive reduced tacrolimus dosing, mycophenolate acid, and early corticosteroid withdrawal. The two primary endpoints were first biopsy-proven acute rejection (BPAR) and any viral viremia. In allowing for a similar follow-up period, all clinical outcomes were compared during the first 24 months (mo) post-transplant. In addition, multivariable analyses were performed adjusting for the propensity to belong to the single-dose ITT rATG group.
RESULTS: Median follow-up in both groups was 24 mo post-transplant. In the single-dose ITT rATG group, a higher proportion of patients developed a first BPAR [P = 0.10; 34.0% (17/50) vs. 21.4% (9/42)], while a lower proportion developed any viral viremia [P = 0.08; 28.0% (14/50) vs. 47.6% (20/42)]. Two baseline variables were associated with a significantly higher propensity to belong to the single-dose ITT rATG group: older recipient age (P = 0.02) and longer WIT (P = 0.02). After adjusting for the propensity score in multivariable analyses, the single-dose ITT rATG group remained associated with a higher first BPAR rate (P = 0.06) but was no longer associated with the rate of viral viremia (P = 0.30). Estimated graft survival at 24 mo post-transplant (combined across both groups) was 92.9% ± 2.8%.
CONCLUSIONS: A lower rate of first BPAR but a somewhat higher rate of viral infection was observed in the three-dose ITT rATG group. These study results support the use of tailored induction protocols to optimize effective immunosuppression while minimizing adverse effects in pediatric kidney transplantation.