Induction therapy in pediatric renal allograft recipients: Improved survival in african-american (AA) patients

AA renal transplant (RT) recipients tend to have a much lower graft survival than white recipients. At the University of Tennessee, Memphis, for 21 AA pediatric first RT recipients before use of induction therapy, one and 3 year predicted graft survival (PGS) was 65% and 40%, respectively. Of these 21, nine were cadaveric (CAD) and 12 living related donor (LRD) recipients. The 1995 annual report from the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS) found that AA CAD and LRD recipients had 60% and 72% three year PGS, respectively. In a large population of predominantly adult CAD RT recipients Gaston et al (Transplantation 53:103, 1992) showed that early treatment with Minnesota anti-lymphocyte globulin resulted in similar PGS for AA and whites. The 1995 NAPRTCS report indicated that 65% of all CAD pediatric recipients received induction therapy. Since 1990 induction therapy with either OKT3 or antithymocyte globulin (ATGAM) has been used for all pediatric RT recipients in our program. Twelve AA first RT recipients received induction therapy: nine CAD (8 with OKT3, one with ATGAM) and 3 LRD (all ATGAM). One CAD recipient also received a liver transplant with the RT. Age at RT ranged from 2.1 to 17.5 years (mean = 11.6 years). Subsequent immunosuppression was with prednisone, azathioprine and cyclosporine A. PGS was estimated by Kaplan-Meier method. PGS for 12 AA patients was 92% at one and 3 years. Nine CAD recipients had a PGS of 89% at one and 3 years. Based upon our limited experience, induction therapy appears to provide excellent renal allograft survival for AA pediatric recipients. In conclusion, we recommend that AA pediatric patients should not be transplanted without benefit of such therapy. A larger study is needed to determine whether OKT3 or an ATG/ALG preparation is best for such therapy.