{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T06:17:48Z","timestamp":1778566668032,"version":"3.51.4"},"reference-count":36,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T00:00:00Z","timestamp":1778544000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"\n Background<\/jats:title>\n We retrospectively compared two distinct dual-induction strategies in pediatric kidney transplantation.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n Patients transplanted at our center prior to 15 February 2020 were scheduled to receive three doses of rabbit antithymocyte globulin (rATG; 1.0\u2005mg\/kg\/dose) along with two doses of basiliximab (\n N<\/jats:italic>\n \u2009=\u200942), while patients transplanted thereafter were scheduled to receive a single dose of rATG with two doses of basiliximab (\n N<\/jats:italic>\n \u2009=\u200950). Both intent-to-treat (ITT) groups were scheduled to receive reduced tacrolimus dosing, mycophenolate acid, and early corticosteroid withdrawal. The two primary endpoints were first biopsy-proven acute rejection (BPAR) and any viral viremia. In allowing for a similar follow-up period, all clinical outcomes were compared during the first 24 months (mo) post-transplant. In addition, multivariable analyses were performed adjusting for the propensity to belong to the single-dose ITT rATG group.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Median follow-up in both groups was 24 mo post-transplant. In the single-dose ITT rATG group, a higher proportion of patients developed a first BPAR [\n P<\/jats:italic>\n \u2009=\u20090.10; 34.0% (17\/50) vs. 21.4% (9\/42)], while a lower proportion developed any viral viremia [\n P<\/jats:italic>\n \u2009=\u20090.08; 28.0% (14\/50) vs. 47.6% (20\/42)]. Two baseline variables were associated with a significantly higher propensity to belong to the single-dose ITT rATG group: older recipient age (\n P<\/jats:italic>\n \u2009=\u20090.02) and longer WIT (\n P<\/jats:italic>\n \u2009=\u20090.02). After adjusting for the propensity score in multivariable analyses, the single-dose ITT rATG group remained associated with a higher first BPAR rate (\n P<\/jats:italic>\n \u2009=\u20090.06) but was no longer associated with the rate of viral viremia (\n P<\/jats:italic>\n \u2009=\u20090.30). Estimated graft survival at 24 mo post-transplant (combined across both groups) was 92.9%\u2009\u00b1\u20092.8%.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n A lower rate of first BPAR but a somewhat higher rate of viral infection was observed in the three-dose ITT rATG group. These study results support the use of tailored induction protocols to optimize effective immunosuppression while minimizing adverse effects in pediatric kidney transplantation.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fped.2026.1699921","type":"journal-article","created":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T05:43:56Z","timestamp":1778564636000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Retrospective comparison of two distinct dual-induction strategies in pediatric kidney transplantation: three doses vs. a single dose of rabbit antithymocyte globulin, each combined with two basiliximab doses"],"prefix":"10.3389","volume":"14","author":[{"given":"Gaetano","family":"Ciancio","sequence":"first","affiliation":[{"name":"Department of Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital","place":["Miami, FL, United States"]},{"name":"Department of Urology, University of Miami Miller School of Medicine, Jackson Memorial Hospital","place":["Miami, FL, United States"]},{"name":"Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital","place":["Miami, FL, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeffrey J.","family":"Gaynor","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital","place":["Miami, FL, United States"]},{"name":"Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital","place":["Miami, FL, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mahmoud","family":"Morsi","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital","place":["Miami, FL, United States"]},{"name":"Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital","place":["Miami, FL, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angel","family":"Alvarez","sequence":"additional","affiliation":[{"name":"Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital","place":["Miami, FL, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew","family":"Gaynor","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital","place":["Miami, FL, United States"]},{"name":"Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital","place":["Miami, FL, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marissa","family":"Defreitas","sequence":"additional","affiliation":[{"name":"Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital","place":["Miami, FL, United States"]},{"name":"Divison of Pediatric Nephrology, Department of Pediatrics, University of Miami Miller School of Medicine, Jackson Memorial Hospital","place":["Miami, FL, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jayanthi","family":"Chandar","sequence":"additional","affiliation":[{"name":"Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital","place":["Miami, FL, United States"]},{"name":"Divison of Pediatric Nephrology, Department of Pediatrics, University of Miami Miller School of Medicine, Jackson Memorial Hospital","place":["Miami, FL, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,12]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"e13953","DOI":"10.1111\/petr.13953","article-title":"Late first acute rejection in pediatric 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