Third dose of basiliximab in pediatric renal transplantation

Antibody induction therapy is frequently used in pediatric renal transplantation to reduce risk of early rejection. We previously reported lower rates of human herpes virus type 6 (HHV-6) reactivation in patients receiving monoclonal antibody induction with basiliximab, compared to patients receiving antithymocyte globulin/antilymphocyte globulin treatment. Subclinical rejection events were still present in many patients in the first 6 months after transplantation. This prompted a third dose of basiliximab to be administered at day 21 in addition to the standard two doses given immediately prior to transplantation and on day 4. No significant reduction of subclinical rejections was noted in the 11 patients receiving triple dosing of basiliximab. Two patients developed an allergic reaction responsive to intravenous fluids, steroids, and antihistamines with full resolution within 30 minutes of administration. There was no increase in de novo infection or reactivation of HHV-6 or Epstein-Barr virus in this group compared to patients receiving two doses of basiliximab. The goal of reduction of early subclinical rejection events was not achieved with the third dosing of basiliximab in this initial group of pediatric renal transplant patients. However, 63.6% of patients receiving triple basiliximab remained free of clinical and/or subclinical rejection for the first 6 months posttransplant compared to only 36.4% remaining rejection-free for the same interval in the group who received the conventional two doses of basiliximab.