The article is dedicated to an extremely important issue of pediatric nephrology and pediatric transplantology-vaccination of children with chronic kidney disease for prevention of vaccinemanageable infections. Commonplace and often mild (in healthy children) viral and bacterial infections in the patients on immunosuppressive therapy may cause development of lifethreatening conditions and loss of a transplant in children with transplanted kidneys. There are no common vaccination protocols for such children neither in Russia nor in any other country. Moreover, it is presumed that vaccination should not take place in children with chronic renal diseases, especially in the stage of renal failure; however, in many cases it is unreasonable. The authors present personal experience of children's vaccination before and after kidney transplantation.
Background. Kidney transplantation efficacy is limited by immunosuppression nephrotoxicity, antibody-mediated and chronic rejection. Avoiding immunosuppression nephrotoxicity is a promising strategy to improve long term outcomes. Belatacept, a synthetic immunoglobulin which blocks CD28-B7 pathway of T-lymphocyte costimulation, is considered as an alternative to calcineurin inhibitors in maintenance immunosuppression since it has no nephrotoxicity. Purpose: to evaluate belatacept efficacy and safety for maintenance immunosuppression therapy after kidney transplantatin based on the clinical experience.Material and methods. From March 2017 to May 2018, we used belatacept in five kidney transplant recipients (one female and four males aged from 4 to 21 years) in the Kidney Transplantation Department of Petrovsky National Research Centre of Surgery Three kidneys were taken from related living donors, two kidney grafts were from deceased donors. Conversion from CNI to belatacept was performed between 6 and 112 month after transplantation. Patients were followed-up for average 12 months after conversion. We have described here these five cases, providing individual indications and the outcome of conversion.Results. The conversion failed in two children switched to belatacept with the purpose to improve compliance. Three patients switched to belatacept because of tacrolimus toxicity demonstrated good results in one year follow up.Conclusion. Belatacept demonstrated good results if was used instead of calcineurin inhibitors when the latter were poorly tolerated. The use of belatacept in multidrug immunosuppression in noncompliant patients was ineffective.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.