Efficacy and tolerability of interleukin-2 receptor blockade with basiliximab in pediatric renal transplant recipients

Rejection remains a major threat in pediatric renal transplantation (Tx), c ausing graft failure and increased exposure to drugs. The new chimeric anti body, basiliximab, directed against the alpha -chain of the interleukin-2 r eceptor (IL-2R), has been shown to be effective in preventing rejection epi sodes in adult renal transplant recipients. In our single-center experience from Essen, Germany, we evaluated prospectively the efficacy and tolerabil ity of basiliximab, in combination with cyclosporin A (CsA) and prednisone, in 38 unselected pediatric patients. Mean patient age at Tx was 10.1 yr. T wenty-eight children received a cadaveric organ and 10 children received li ving-related donor grafts. The 1-yr patient survival rate was 100% and the 1-yr graft survival rate was 95% (36/38 patients). No graft was lost as a r esult of immunological factors, and single rejection episodes were observed in eight patients (21%). Two of these rejections were steroid-resistant an d responded to tacrolimus rescue therapy. The rate of infections was not en hanced; overt cytomegalovirus (CMV) disease was observed in two patients on ly. Malignancies have not been seen to dais. The blockade of the alpha -cha in of the IL-2R lasted for up to 6 weeks. We conclude that the addition of basiliximab to standard immunosuppression in pediatric renal transplant rec ipients is well tolerated and results in a low incidence of rejection. The simple mode of application and the lack of side-effects make basiliximab an especially useful adjunct in pediatric patients.