{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T23:18:32Z","timestamp":1790983112922,"version":"4.1.0"},"reference-count":30,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T00:00:00Z","timestamp":1787788800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T00:00:00Z","timestamp":1787788800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Transplantation"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Acute kidney allograft rejection is a significant cause of graft dysfunction in pediatric transplant recipients. Standard of care for moderate to severe acute T\u2010cell\u2010mediated rejection among pediatric transplant recipients includes lymphocyte\u2010depleting agents such as rabbit anti\u2010thymocyte globulin (rATG). However, intolerance to or contraindications to rATG may limit its use and necessitate alternative immunosuppressive strategies. Alemtuzumab, a humanized monoclonal antibody targeting CD52, induces profound depletion of T\u2010 and B\u2010 lymphocytes and has been used in the transplantation setting. However, data remain limited for pediatric rejection, and the precise role for alemtuzumab is not well defined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case Presentation<\/jats:title>\n                    <jats:p>We report a 12\u2010year\u2010old male with end\u2010stage kidney disease secondary to congenital renal dysplasia who underwent deceased donor kidney transplantation and presented 9\u2009years post\u2010transplant with acute allograft dysfunction. Evaluation revealed a rise in serum creatinine, subtherapeutic tacrolimus levels, and increased donor\u2010specific antibodies. Kidney biopsy demonstrated Banff grade IIA T\u2010cell\u2010mediated rejection with features of antibody\u2010mediated rejection. Initial treatment included high\u2010dose corticosteroids and intravenous immunoglobulin. rATG therapy was initiated but discontinued due to anaphylaxis. The patient subsequently received a 30\u2010mg dose of subcutaneous alemtuzumab, which was well tolerated. B\u2010 and T\u2010lymphocyte populations were suppressed on flow cytometry analysis. Kidney function significantly improved, repeat biopsy showed marked improvement in tubulointerstitial inflammation, and graft function remained stable at follow\u2010up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This case highlights the potential role of alemtuzumab as an alternative lymphocyte\u2010depleting therapy for the treatment of acute rejection in pediatric kidney transplant recipients, particularly when rATG is contraindicated. Moreover, treatment with alemtuzumab may preclude the need for additional B\u2010cell directed therapy in cases of mixed T\u2010cell\u2010 and antibody\u2010mediated rejection. Further studies are needed to better define its safety, efficacy, and optimal role in this population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/petr.70446","type":"journal-article","created":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T05:24:55Z","timestamp":1787894695000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Subcutaneous Alemtuzumab as Salvage Therapy for Acute Kidney Transplant Rejection Following Thymoglobulin Anaphylaxis: A Pediatric Case Report"],"prefix":"10.1111","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5121-623X","authenticated-orcid":false,"given":"Kevin W.","family":"O'Connor","sequence":"first","affiliation":[{"name":"Department of Pediatrics Johns Hopkins University School of Medicine  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9092-3313","authenticated-orcid":false,"given":"Serena","family":"Bagnasco","sequence":"additional","affiliation":[{"name":"Department of Pathology Johns Hopkins University School of Medicine  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4253-9242","authenticated-orcid":false,"given":"Cozumel","family":"Pruette","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Johns Hopkins University School of Medicine  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-0857-1697","authenticated-orcid":false,"given":"Elizabeth","family":"Goswami","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Johns Hopkins Hospital  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1104-2882","authenticated-orcid":false,"given":"Olga","family":"Charnaya","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Johns Hopkins University School of Medicine  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,27]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1314376"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/petr.13856"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/petr.13953"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/PETR.13694"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMOA1009546;ISSUE:ISSUE:DOI"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0B013E31819D3353"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1086\/510388"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/PETR.14173"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1081\u20101206(10)62535\u20105"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.2500\/AAP.2023.44.230034"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/J.TRANSPROCEED.2014.07.070"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMOA060068;WGROUP:STRING:MMS"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.V91121"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.3389\/FIMMU.2022.1017872\/PDF"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/J.1365\u20102567.2009.03115.X"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1042\/BJ2930633"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(14)61095\u20103"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD004759.PUB2"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0B013E318257AD41"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600\u20106143.2012.04328.x"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.transproceed.2021.07.005"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0000000000001416"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1111\/petr.13685"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.3389\/ti.2023.11834"},{"key":"e_1_2_7_26_1","doi-asserted-by":"publisher","DOI":"10.1111\/J.1399\u20103046.2011.01615.X"},{"key":"e_1_2_7_27_1","doi-asserted-by":"publisher","DOI":"10.6002\/ECT.2018.0203"},{"key":"e_1_2_7_28_1","unstructured":"\u201cCampath (ALEMTUZUMAB) Package Insert \u201dhttps:\/\/www.accessdata.fda.gov\/drugsatfda_docs\/label\/2001\/alemmil050701LB.htm."},{"key":"e_1_2_7_29_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.TP.0000295718.55669.3A"},{"key":"e_1_2_7_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.trim.2025.102179"},{"key":"e_1_2_7_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajt.2025.07.2024"}],"container-title":["Pediatric Transplantation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/petr.70446","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/petr.70446","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/petr.70446","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T23:53:11Z","timestamp":1790380391000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/petr.70446"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,27]]},"references-count":30,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1111\/petr.70446"],"URL":"https:\/\/doi.org\/10.1111\/petr.70446","archive":["Portico"],"relation":{},"ISSN":["1397-3142","1399-3046"],"issn-type":[{"value":"1397-3142","type":"print"},{"value":"1399-3046","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,27]]},"assertion":[{"value":"2026-04-29","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-21","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-27","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70446"}}