Anti- XXXX receptor antibodies for the prevention of rejection in pediatric renal transplant @entity1 : current status.

@entity1 @entity407 @entity851 @entity1071 @entity101 @entity6 @entity137 @entity5 @entity228 @entity2902 @entity1199
The anti- @entity1199 receptor (anti- @entity2902 ) antibody therapy is an exciting approach to the prevention of acute rejection after renal allograft transplantation whereby immunosuppression is exerted by a selective and competitive inhibition of @entity1199 -induced T cell proliferation, a critical pathway of allorecognition. The anti- @entity2902 antibodies specifically block the alpha-subunit of the @entity2902 on activated T cells, and prevent T cell proliferation and activation of the effector arms of the immune system. The anti- @entity2902 antibodies are used as induction therapy, immediately after renal transplantation, for prevention of acute cellular rejection in @entity1 and adults. During acute rejection, the @entity2902 chain is no longer expressed on T cells; thus, the antibodies cannot be used to treat an existing acute rejection. Two anti- @entity2902 monoclonal antibodies are currently in clinical use: daclizumab and basiliximab. In placebo-controlled phase III clinical trials in adults, daclizumab and basiliximab in combination with calcineurin inhibitor-based immunosuppression, significantly reduced the incidence of acute rejection and @entity228 -resistant acute rejection without increasing the risk of @entity5 , and neither antibody was associated with the cytokine-release syndrome. @entity1 who receive calcineurin inhibitors and corticosteroids for maintenance immunosuppression, as well as @entity1 who receive augmented immunosuppression to treat acute rejection, are at increased risk of @entity851 , @entity101 , @entity407 , @entity1071 , @entity6 , and cosmetic changes. In older @entity1 , the cosmetic adverse effects frequently reduce compliance with the treatment, and subsequently increase the risk of allograft loss. Being effective and well tolerated in children, the anti- @entity2902 antibodies reduce the need for calcineurin inhibitors while maintaining the overall efficacy of the regimen; thus, the anti- @entity2902 antibodies increase the safety margin (less @entity137 , fewer adverse effects) of the baseline immunosuppression. Secondly, the anti- @entity2902 antibodies decrease the need for corticosteroids and muromonab CD3 (OKT3) in @entity1 as a result of decreased incidence of acute rejection. The recommended pediatric dose of daclizumab is 1 mg/kg intravenously every 14 days for five doses, with the first dose administered within 24 hours pre-transplantation. This administration regimen maintains daclizumab levels necessary to completely saturate the @entity2902 (5-10 microg/mL) in @entity1 for at least 12 weeks.The recommended pediatric dose of basiliximab for recipients <35 kg is 10 mg, and 20 mg for recipients > or =35 kg, intravenously on days 0 and 4 post-transplantation. This administration regimen maintains basiliximab levels necessary to completely saturate the @entity2902 (>0.2 microg/mL) in @entity1 for at least 3 weeks.
