Long‐term outcomes of two‐dose alemtuzumab induction in pediatric kidney transplantation

Abstract Background Alemtuzumab is a lymphocyte depleting agent used for induction in kidney transplant, but long‐term information on its use in pediatric recipients remains sparse. Methods We performed a single‐center retrospective cohort study of 57 pediatric kidney transplant recipients receiving alemtuzumab 20 mg/m 2 /dose ×2 doses for induction immunosuppression. All patients underwent surveillance biopsies, and 91.3% underwent steroid withdrawal by day 4 post‐transplant. Outcomes of interest included graft survival, development of donor specific antibodies (DSA), incidence of viremia and PTLD, and duration of lymphopenia. Results Median follow‐up time was 7.9 years (IQR 5–13.6 years). Median graft survival was 16.5 years (95% CI 11.6‐unknown). DSA developed in 36.5% at a median of 944 days (IQR 252–2113 days). Incidences of BK polyomavirus DNAemia (BKPyV‐DNAemia), CMV DNAemia, and EBV DNAemia were 38.6%, 22.8%, and 14%, respectively; one patient developed PTLD at 13.3 years post‐transplant. Median duration of lymphopenia was 365 days (IQR 168–713 days); 19.3% of patients remained lymphopenic at 3 years post‐transplant. There was no association between duration of lymphopenia and graft survival, rejection, DSA detection, or viremia. Conclusions A two‐dose alemtuzumab induction protocol can have excellent outcomes with a steroid‐free maintenance immunosuppression regimen. More comprehensive, multicenter, comparative studies of pediatric kidney transplant are needed to improve long‐term outcomes.