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Published on: April 13, 2021
Clinical description and evolution of renal transplant pediatric patients treated with alemtuzumab
1Department of Pediatric Nephrology, Pablo Tobón Uribe Hospital, Medellín, Colombia.
Insights
Alemtuzumab induction in pediatric kidney transplants showed improved graft survival and lower rejection rates. While Cytomegalovirus infections were more frequent, overall safety was demonstrated for this renal transplantation approach.
Area of Science:
- Pediatric Nephrology
- Transplantation Immunology
- Clinical Pediatrics
Background:
- Renal transplantation is the primary treatment for pediatric end-stage renal disease.
- Alemtuzumab induction therapy may allow lower maintenance immunosuppression doses and is cost-effective.
- Previous studies suggest potential benefits of alemtuzumab in pediatric renal transplant recipients.
Purpose of the Study:
- To compare pediatric renal transplant outcomes based on induction protocols.
- To evaluate graft and patient survival, infection complications, and lymphoproliferative diseases.
- To assess the safety and efficacy of alemtuzumab versus other induction agents.
Main Methods:
- Descriptive and retrospective study design.
- Evaluation of pediatric renal transplant patients from 2006 to 2010.
- Comparison of induction therapies including alemtuzumab, daclizumab, and thymoglobulin.
Main Results:
- Alemtuzumab was used in 61.5% of cases; daclizumab and thymoglobulin in 19.25% each.
- Graft survival was higher with alemtuzumab (87.5%) compared to others (80%).
- Lower rates of acute and chronic rejection were observed with alemtuzumab; Cytomegalovirus infection occurred more frequently (30%).
Conclusions:
- Alemtuzumab induction is safe in pediatric renal transplantation, without increasing acute or chronic rejection risk.
- No significant differences in complications were noted, apart from a higher incidence of Cytomegalovirus infections.
- Alemtuzumab represents a viable induction strategy for pediatric kidney transplant recipients.
Background:
Renal transplantation is the most effective treatment for children with end-stage renal disease. Recent work suggests that induction with alemtuzumab in the pediatric population permits the use of lower doses of maintenance immunosuppressive therapy. In addition, it has a low cost compared with other induction therapies.
Objective:
To conduct a clinical description of pediatric renal transplant patients comparing induction protocols to evaluate graft and patient survival, infections complications, and lymphoproliferative diseases.
Materials And Methods:
This descriptive and retrospective study, of evaluated pediatric renal transplant patients between 2006 and 2010.
Results:
The agents for induction therapy were: alemtuzumab (61.5%), daclizumab (19.25%), and thymoglobulin (19.25%). Graft survival was better among the alemtuzumab group (87.5%) compared with the other two induction therapies (80%). The frequency of acute rejection episodes during the first year posttransplantation as well as chronic rejection was lower among the alemtuzumab group. Cytomegalovirus infection was noted in 30% of patients with greater frequency among those induced with alemtuzumab.
Conclusion:
Induction therapy with alemtuzumab was safe in a pediatric population not predisposing to a greater risk of acute or chronic rejection. Except for a greater incidence of Cytomegalovirus, there was no difference in other complications.
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