Induction and maintenance immunosuppression in pediatric kidney transplantation—Advances and controversies

Abstract

Organ transplantation is a life-saving therapy that has revolutionized the field of medicine over the last 100 years. The first successful non-identical kidney transplant was performed in a 24-year-old man in 1959 using total body irradiation for immunosuppression. This was the first instance of the permeation of the immunological barrier to organ transplantation. In early 1960s, the immunosuppressive properties of (AZA) and prednisone were recognized, and in 1966, the immunosuppressive effects of antilymphocyte serum were discovered. 1 These early discoveries transformed the field of organ transplantation from a mere vision to a promising reality. As illustrated by a retrospective study of 56 pediatric kidney transplant recipients, transplanted between 1963 and 1971, 1-year graft survival in living-donor recipients improved from 50% before antilymphocyte serum to nearly 90% after the institution of antilymphocyte serum in conjunction with AZA and prednisone. 2 The next major advance in immunosuppression occurred in 1976 when J.F Borel discovered (CSA). 1 The discovery of CSA (FDA approved in 1983) was particularly important for children, as it allowed

BK DNAemia in pediatric kidney transplant recipients: Predictors and outcomes

“…Furthermore, most patients received tacrolimus and mycophenolate for maintenance IS as opposed to cyclosporine and azathioprine. We also used higher doses of mycophenolate (600 mg/m 2 ) in conjunction with tacrolimus compared with the recommended dose of 450 mg/m 2 in this setting 12 . Having said this, the incidence of BK DNAemia in our study is comparable with that previously reported in the pediatric literature 7–9 .…”

mTOR regulates T cell exhaustion and PD-1–targeted immunotherapy response during chronic viral infection

“…mTOR is a serine/threonine kinase that regulates several key cellular processes including translation, autophagy, and metabolism (21,22). Rapamycin, a specific inhibitor of mTOR, and its analogs are currently used as immunosuppressive drugs in transplant recipients (23,24).…”

Implantable Immunosuppressant Delivery to Prevent Rejection in Transplantation

“…Implantable immunosuppressant delivery can be made through various systems, such as hydrogels, nano/microparticles [33], micelles [34], microspheres [33], and liposomes [35] (Figure 2). Several implantable immunosuppressant deliveries applied in transplantation are sum- Broadly speaking, the transplant recipients may receive pharmacological treatments during the induction, maintenance, or rejection phases [28,29] based on the post-transplant time and the specific infection/rejection profile status [13,30]. Treatment during the induction phase aims to immediately eradicate the immune response, while treatment during the maintenance phase seeks to maintain the tolerant condition in which the immune system is sufficiently suppressed to minimize allograft rejection but is still able to respond to infections [31].…”