Considerations and controversies of pharmacologic management of the pediatric kidney transplant recipient

Abstract

Pediatric kidney transplantation has experienced considerable growth and improvement in patient and allograft outcomes over the past 20 years, in part due to advancements in immunosuppressive regimens and management. Despite this progress, care for this unique population can be challenging due to limited pediatric transplant data and trials, intricacies related to differences in children and adolescents compared with their adult counterparts, and limitations to long‐term survival facing all solid organ transplant populations. Immunosuppression and infection prevention practices vary from one pediatric transplant center to another and clinical controversies exist surrounding treatment and dosing. This review aims to summarize key aspects of pharmacologic management in this population and present pertinent data that describe the influence of practice to serve as a resource for practitioners caring for this unique specialty patient population. Additionally, this review highlights select controversies that exist within pediatric kidney transplantation.

A Multi-step High-Performance Liquid Chromatography (HPLC) Technique for the Extraction and Purification of Medical-Grade Cyclosporine A

“…3 In the early 1970s, Brayman and colleagues reported CsA as a good medication for human organ transplantation. 5 The U.S. Food and Drug Administration (FDA) approved it for clinical kidney transplantation in 1983. 5 In the same year, the Fujian Institute of Microbiology discovered and isolated CsA from another cyclosporine-producing fungus, Fusarium Solan, in Chinese soil.…”

“…5 The U.S. Food and Drug Administration (FDA) approved it for clinical kidney transplantation in 1983. 5 In the same year, the Fujian Institute of Microbiology discovered and isolated CsA from another cyclosporine-producing fungus, Fusarium Solan, in Chinese soil. 5 In terms of physical and chemical characteristics, 6 as well as spectral detection, 4 the CsA isolated from Fusarium solanacearum and the foreign CsA were identical.…”

“…5 In the same year, the Fujian Institute of Microbiology discovered and isolated CsA from another cyclosporine-producing fungus, Fusarium Solan, in Chinese soil. 5 In terms of physical and chemical characteristics, 6 as well as spectral detection, 4 the CsA isolated from Fusarium solanacearum and the foreign CsA were identical. 7 In 1991, China released the first CsA preparation that it had created independently.…”

Solid organ transplant pharmacotherapy: Complicated and continually changing

“…Although pediatric transplantation is not necessarily considered “unique” or “special,” many transplant clinicians lack robust experience in caring for this population. The article by Liverman et al 14 provides an outstanding comprehensive review of the clinical controversies surrounding immunosuppression management in pediatric kidney transplant recipients.…”