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Pediatric liver transplant with Campath 1H induction--Preliminary report
T Kato1, G Selvaggi, T Panagiotis
1Department of Surgery, University of Miami, Liver and GI Transplant, Miami, Florida 33136, USA.
Insights
Campath 1H (C1H) induction is safe for pediatric liver transplant recipients. C1H improved rejection-free survival in children with autoimmune hepatitis, even with reduced immunosuppression.
Area of Science:
- Pediatric transplantation
- Immunosuppression strategies
- Hepatology
Background:
- Campath 1H (C1H) has a proven safety record in adult liver transplant recipients.
- Pediatric liver transplantation requires tailored immunosuppression protocols.
Purpose of the Study:
- To evaluate the safety and efficacy of Campath 1H (C1H) induction in pediatric liver transplant recipients.
- To assess the impact of C1H on rejection rates and graft function in children.
Main Methods:
- Campath 1H (C1H) induction was administered to 10 pediatric liver transplant recipients (ages 5-17).
- Patients had various underlying conditions including autoimmune hepatitis (AIH), primary sclerosing cholangitis (PSC), and biliary atresia.
- Immunosuppression included C1H, tacrolimus, and limited steroid use; follow-up averaged 679 days.
Main Results:
- All 10 pediatric patients survived with stable graft function.
- Postoperative courses were generally uneventful, with a median hospital stay of 12 days.
- Compared to historical controls, C1H recipients with AIH demonstrated significantly prolonged rejection-free survival.
Conclusions:
- Campath 1H (C1H) induction is well-tolerated in pediatric liver transplant recipients.
- C1H shows promise in prolonging rejection-free survival, particularly in AIH patients, with reduced maintenance immunosuppression.
Unlabelled:
Since Campath 1H (C1H) has been successfully used in adult liver transplant recipients since 2001 in our program, we started to use it in children.
Patients And Methods:
C1H induction was employed in 10 children with autoimmune hepatitis (AIH) (n = 6), primary sclerosing cholangitis (PSC) (n = 1), biliary atresia (n = 1), glycogen storage disease (n = 1), and Wilson's disease. Eight were primary transplants, and two retransplants. Patients ages ranged from 5 to 17 years. C1H was administered at a dose of 0.3 mg/kg on days 0, 4, and 7. Tacrolimus level was maintained at 5 to 10 ng/mL. No patient received maintenance steroids posttransplantation except two who were on steroid therapy at the time transplant. They were prescribed small doses of maintenance steroids. Median follow-up of C1H recipients was 679 days (range 115-1143).
Results:
Postoperative courses were mostly uneventful except for one retransplant recipient who required prolonged hospitalization (40 days) for rehabilitation. Median hospital stay was 12 days (range 7-40 days). All 10 patients in the C1H group are currently alive and well with stable graft function. No opportunistic infection was observed in these patients to date. We compared six patients with AIH who received C1H to the historic control of 10 recipients with AIH who received conventional immunosuppression (tacrolimus + steroid). The patients treated with C1H showed significantly prolonged rejection-free survival.
Conclusion:
In our preliminary experience, C1H induction was well tolerated in pediatric liver recipients. Rejections-free survival was prolonged among recipients with AIH despite a low level of maintenance immunosuppression.
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