Basiliximab versus ATG/ALG induction in pediatric renal transplants: comparison of herpes virus profile and rejection rates

Acott, Philip D.; Lawen, Joseph; Lee, S; Crocker, John F. S.

doi:10.1016/s0041-1345(01)02354-5

Cited by 16 publications

(13 citation statements)

References 7 publications

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“…A trend toward more frequent HHV‐6 and HHV‐7 reactivation in patients receiving basiliximab than in those receiving rabbit antithymocyte globulin was observed, in contrast with previous studies concerning HCMV or HHV‐6 [Acott et al, 2001]. Although the number of patients was too small to make definitive conclusions, the most powerful combination (corticosteroids‐tacrolimus‐mycophenolate mofetil) tended to result in more frequent HHV‐7 replication, whereas sirolimus appeared to be associated with less frequent HHV‐6 detection.…”

Section: Discussioncontrasting

confidence: 99%

“…However, a low percentage of HHV‐6 primary infections during the first year after transplantation has been observed in adult solid‐organ transplant patients, and these infections were associated with few symptoms [Cervera et al, 2006]. Immunosuppression and the different treatments associated with transplantation may also enhance HHV‐6 and HHV‐7 replication [Acott et al, 2001], although there is no consensus concerning the correlation of transplantations with clinical manifestations [Brennan et al, 2000; Tong et al, 2000; Koukourgianni et al, 2009]. In infants and adults, HHV‐6 is associated with graft rejection, with the presence of viral antigens in the rejected kidney [Okuno et al, 1990; Yalcin et al, 1994; Wade et al, 1998].…”

Section: Introductionmentioning

confidence: 99%

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Confirmation of the low clinical effect of human herpesvirus‐6 and ‐7 infections after renal transplantation

Caïola¹,

Karras

Flandre

et al. 2012

Journal of Medical Virology

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Human herpesvirus-6 and -7 (HHV-6 and HHV-7) may lead to pathological manifestations in renal transplant recipients. The aim of this study was to investigate beta-herpesvirus infections in 50 adult kidney transplant recipients after transplantation to examine the effect, interactions, and pathogenic consequences of infection and the effect of immunosuppressive regimens and Human cytomegalovirus (HCMV) prophylaxis with VACV. Beta-herpesviruses loads in the blood of 50 adult kidney transplant recipients over a 6-month period after transplantation and 198 blood donors were determined using polymerase chain reaction. The rate of HHV-6 detection in peripheral mononuclear cells (PBMCs) was higher in patients with end-stage renal disease and during the posttransplantation follow-up than in healthy subjects (33% and 68% vs. 12%, respectively). The detection rate of HHV-7 in PBMCs was similar between patients, both before grafting and during the follow-up for transplant recipients (69% and 88%, respectively), and healthy subjects (78%), and correlated with the number of lymphocytes. HCMV in plasma was detected only in patients during the post-transplant period (24%). VACV prophylaxis had no negative effect on the replication of HHV-6 or HHV-7, and univariate analyses demonstrated associations between HHV-6 infection and acute graft rejection [Odds ratio (OR) ¼ 2.94, 95% confidence interval (CI), 1.05-8.2, P ¼ 0.04], and between HHV-7 infection and cholestasis [OR ¼ 2.61 (95% CI, 1.08-6.3), P ¼ 0.03]. Immunosuppressive regimens had no effect on beta-herpesviruses infections. This study revealed the differing behavior of HCMV, HHV-6, and HHV-7 in kidney transplant recipients, and confirmed the association of HHV-6 with graft rejection.J. Med. Virol. 84:450-456, 2012. KEY WORDS: human herpesvirus-6; human herpesvirus-7; human cytomegalovirus; viral load; renal transplantation; graft rejection; antiviral prophylaxis; immunosuppressive regimen INTRODUCTIONHuman herpesvirus-6 and -7 (HHV-6 and HHV-7) are related to the human cytomegalovirus (HCMV) [Lawrence et al., 1990]. After primary infection, which Abbreviations: HCMV, human cytomegalovirus; HHV-6, human herpesvirus-6; HHV-7, human herpesvirus-7; CNS, central nervous system; EqCop, number of viral genomic equivalent copies; PBMCs, peripheral blood mononuclear cells; VACV, valacyclovir. is primarily asymptomatic or associated with febrile illnesses including exanthema subitum, HHV-6 and HHV-7 remain latent in a majority of adults [Yamanishi et al., 1988;Hidaka et al., 1994]. In some cases, primary infection with HHV-6 may lead to serious illnesses, particularly meningoencephalitis and hepatitis [Asano et al., 1990;Yoshikawa and Asano, 2000]. HHV-6 reactivation may lead to pathological complications, particularly in immunocompromised individuals, whereas HHV-7 exhibits no opportunistic behavior [Boutolleau et al., 2003]. Thus, in solid-organ transplant recipients, the reactivation of HHV-6 is frequent and usually asymptomatic. However, clinical complications may occur, inclu...

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Section: Discussioncontrasting

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Confirmation of the low clinical effect of human herpesvirus‐6 and ‐7 infections after renal transplantation

Caïola¹,

Karras

Flandre

et al. 2012

Journal of Medical Virology

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“…When compared with other immunosuppressive therapy for patients undergoing renal transplantation, basiliximab has been shown to offer improved graft survival with a low incidence of acute rejection and a more favorable adverse effect profile. 7,9 The initial reports in pediatric patients have demonstrated the safety of this medication with a reported experience in at least 200 patients without adverse effects. 3 Á 8 .…”

Section: Discussionmentioning

confidence: 99%

Acute cardiorespiratory compromise in two adolescents following basiliximab therapy during living-related renal transplantation

Skorokhod

Groshong

Tobias

2003

Clinical Intensive Care

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Basiliximab (Simulect, Novartis, Summit, New Jersey) is a chimeric human/mouse antibody specific for the interleukin II receptor expressed on activated T lymphocytes. Initial experience has demonstrated it to be an effective immunosuppressive agent for patients undergoing renal transplantation. To date, there are limited reports regarding adverse effects following its administration. We present two patients who received intraoperative doses of basiliximab and who subsequently developed cardiorespiratory compromise during living-related renal transplantation. One patient developed post-operative non-cardiogenic pulmonary edema while the second patient developed myocardial dysfunction manifested by hypotension, bradycardia and asystole. Although a direct causal relationship cannot definitively be proven, other etiologies for the cardiorespiratory compromise were ruled out and the most likely etiologic factor was thought to be basiliximab.

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“…In pediatric renal transplantation recipients Clark and colleagues (2002) reported an insignifi cant difference in global CMV infection favoring basiliximab compared with antilymphocyte globulin, but these differences were statistically signifi cant in recipients who were seropositive for CMV antibodies (0/16 vs 8/156; p Ͻ 0.01). Also in children treated with IL-2R monoclonal antibodies Acott et al (2001) demonstrated a tendency towards fewer infections caused by human herpes virus type 6 and by Epstein Barr virus and a lower incidence of thrombocytopenia and unexplained fever, compared to lymphocyte-depleting antibodies.…”

Section: Drug Safety and Costmentioning

confidence: 96%

“…Fewer CMV infections were observed in the basiliximab group (10% vs 19%, NS), particularly in children exposed to seropositive combinations (p Ͻ 0.01). In a retrospective analysis from Canada (Acott et al 2001), 23 children treated with basiliximab induction, cyclosporin, azathioprine and corticosteroids were compared to the outcomes in 27 historical controls treated with rabbit ATG or horse antilymphocyte globulin and the same maintenance immunosuppressives. Biopsy-confi rmed acute rejection at six months was 9% in the basiliximab group and 33% in the lymphocyte-depleting group.…”

Section: Basiliximab Vs Other Inducing Agentsmentioning

confidence: 99%

The role of basiliximab in the evolving renal transplantation immunosuppression protocol

Salis

Caccamo

Verzaro

et al. 2008

BTT

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Basiliximab is a chimeric mouse-human monoclonal antibody directed against the alpha chain of the interleukin-2 (IL-2) receptor on activated T lymphocytes. It was shown in phase III trials to reduce the number and severity of acute rejection episodes in the fi rst year following renal transplantation in adults and children, with a reasonable cost-benefi t ratio. The drug does not increase the incidence of opportunistic infections or malignancies above baseline in patients treated with conventional calcineurin inhibitor-based immunosuppression. In the fi eld of renal transplantation, basiliximab does not increase kidney or patient survival, despite the reduction in the number of rejection episodes. Basiliximab may reduce the incidence of delayed graft function. In comparison with lymphocyte-depleting antibodies basiliximab appears to have equal effi cacy in standard immunological risk patients. Recently, IL-2 receptor monoclonal antibodies have been used with the objective of reducing or eliminating the more toxic elements of the standard immunosuppression protocol. Several trials have incorporated basiliximab in protocols designed to avoid or withdraw rapidly corticosteroids, as well as protocols which substitute target-of-rapamycin (TOR) inhibitors for calcineurin inhibitors.

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Basiliximab versus ATG/ALG induction in pediatric renal transplants: comparison of herpes virus profile and rejection rates

Cited by 16 publications

References 7 publications

Confirmation of the low clinical effect of human herpesvirus‐6 and ‐7 infections after renal transplantation

Confirmation of the low clinical effect of human herpesvirus‐6 and ‐7 infections after renal transplantation

Acute cardiorespiratory compromise in two adolescents following basiliximab therapy during living-related renal transplantation

The role of basiliximab in the evolving renal transplantation immunosuppression protocol

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