Table 2.
Mortality and particular postoperative courses
| No. | Gender | Age at tx | Postoperative day | Cause of death |
|---|---|---|---|---|
| (a) Causes of death in 8 of 101 alemtuzumab-treated patients | ||||
| 1 | Girl | 7 yr | 452 | Respiratory failure due to ascending paralysis |
| 2 | Boy | 7 months | 165 | Brain edema due to electrolyte disorders caused by acute kidney obstruction with subsequent urine outflow restoration |
| 3 | Girl | 8 yr | 1457 | Meningococcal meningoencephalitis |
| 4 | Girl | 3 yr | 420 | Unknown |
| 5 | Boy | 2 yr | 548 | PCP |
| 6 | Girl | 11 months | 26 | Pneumonitis, pathogen not specified |
| 7 | Girl | 7 yr | 891 | Pneumonitis, pathogen not specified |
| 8 | Boy | 15 yr | 273 | Pneumonitis, pathogen not specified |
| (b) Clinically apparent EBV and CMV infections and PCP | Outcome | |||
|---|---|---|---|---|
| 1 | Boy | 4 yr | EBV-associated flu like syndrome 6 months post-transplant, resolved after switch from Tacro + MMF to Rapamune | 4 yr, excellent graft function |
| 2 | Boy | 2 yr | PCP developed 1 month post-transplant, completely resolved on trimethoprim-sulfametoxasole | 3 yr, impaired graft function (GFR 20 mL/min) |
| 3 | Boy | 6 yr | CMV-associated pneumonia on day 230, 4 wk apart of steroid-resistant rejection treatment with Campath, completely resolved with 4-wk valganciclovir | 3 yr, excellent graft function |
| 4 | Boy | 4 yr | CMV-associated enteritis 1 yr post-transplant, resolved with 2-wk valganciclovir | 3 yr, excellent graft function |
| (c) Reasons for not withdrawal the steroids in 5 of 101 alemtuzumab-treated patients | |||||||
|---|---|---|---|---|---|---|---|
| 1 | Boy | 7 months | Gastrointestinal infection on day 7 with acute graft failure, CNI was suspended for 4 days, graft function recovered promptly, CNI target level was achieved slowly and proper time for steroid withdrawal was missed | ||||
| 2 | Girl | 8 yr | Delayed graft function until day 28, we preferred to left her on steroids then undergo every week biopsy | ||||
| 3 | Boy | 5 yr | Decortication due to profound and prolonged hypoglycemia, PSI was used instead CNI to avoid neurotoxicity | ||||
| 4 | Girl | 10 yr | Slow graft function (normal creatinine on day 21) caused by artery thrombosis with restoration of blood flow within 1 h | Vulnerability to rejection due to ischemic injury made us continue steroids in these two children | |||
| 5 | Girl | 13 yr | Slow graft function (normal creatinine on day 44) caused by venous kinking with restoration of blood outflow within 4 h | ||||