Comparison of FK-506 and cyclosporine regimens in pediatric renal transplantation

Abstract

Clinical aspects of FK-506 or cyclosporine immunosuppression regimens were evaluated in 48 consecutive pediatric renal transplant recipients. Tapering and discontinuation of prednisone was employed only in children receiving FK-506 who experienced minor or no rejection episodes during the 1st posttransplant month. At 1 year follow-up, 17 of 22 (77%) of all children with functioning allografts were receiving no prednisone (n = 13) or a mean dosage of 0.07 mg/kg per day (n = 4). During the 1st month, acute cellular rejection was more common in the FK-506 group (0.58 vs. 0.21 rejections per patient, P < 0.05) but allograft survival (92%) and renal function at 1 year posttransplant were identical in both groups. Compared with the cyclosporine regimen, FK-506 immunosuppression may be associated with a higher incidence of cytomegalovirus or reversible Epstein-Barr virus-induced lymphoproliferative disease. However, the FK-506 group had less hirsutism and gingival hypertrophy and required fewer antihypertensive medications independent of steroid use. Height standard deviation scores and weight-for-height index improved only in pre-adolescents receiving FK-506 but no prednisone (P < 0.02 and P < 0.05, respectively), but did not differ between children on FK-506 plus prednisone and those in the cyclosporine group. We conclude that the major advantages of FK-506 over cyclosporine immunosuppression are a reduced severity of hypertension and an improved cosmetic appearance which may improve long-term medical compliance. When used as monotherapy, FK-506 also shows promise in relieving the growth retardation associated with cyclosporine regimens that include prednisone.

FK506 in pediatric kidney transplantation—Primary and rescue experience

“…When the analysis was further subdivided into pre-adolescents and adolescents, the most striking growth improvement was in the preadolescent children off steroids. This is in accord with our previous observations, 14 but the magnitude of improvement in growth is more pronounced. At most recent follow-up, the Z score for the pre-adolescents off steroids was + 0.92.…”

“…In fact, our recent retrospective comparison of cyclosporine and FK506 in pediatric kidney transplantation demonstrated comparable patient and graft survival; the big difference was in the ability to discontinue steroids in over half of the FK506-treated patients, and in the associated improvement in growth. [14][15][16] The current update confirms the ability to wean a substantial number of children off steroids under FK506 immunosuppression. The resultant improvement in growth makes FK506 a particularly attractive agent in pediatric transplantation.…”

“…The initial experiences in pediatric kidney transplantation have been previously described. [12][13][14][15][16] Patient and graft survival have been comparable to that seen under cyclosporine immunosuppression, but lower steroid and antihypertensive requirements have been observed with FK506. [14][15][16] In addition, improved growth has been demonstrated in certain subgroups of children on FK506.…”

“…[12][13][14][15][16] Patient and graft survival have been comparable to that seen under cyclosporine immunosuppression, but lower steroid and antihypertensive requirements have been observed with FK506. [14][15][16] In addition, improved growth has been demonstrated in certain subgroups of children on FK506. 14 Of some concern has been the suggestion of a higher incidence of viral complications associated with FK506, although they have all resolved without graft loss or patient death.…”

“…[14][15][16] In addition, improved growth has been demonstrated in certain subgroups of children on FK506. 14 Of some concern has been the suggestion of a higher incidence of viral complications associated with FK506, although they have all resolved without graft loss or patient death. 15,16 FK506 has also been used in an attempt to salvage patients transplanted under cyclosporine immunosuppression.…”