Pediatric renal transplantation under FK-506 immunosuppression

Between December 14, 1989, and December 17, 1993,43 patients undergoing kidney transplantation alone at the Children's Hospital of Pittsburgh received FK506 as the primary immunosuppressive agent. The mean recipient age was 10.2 ± 4.8 years (range 0.7-17.4), with 7 (16%) children under 5 years of age and 2 (5%) under 2 years of age. Fifteen (35%) children underwent retransplantation, and 5 (12%) had a panel reactive antibody level greater than 40%. Twenty-two (51%) cases were with cadaveric donors, and 21 (49%) were with living donors. The mean follow-up is 25 ± 14 months. There were no deaths. One and three year actuarial graft survival was 98% and 85%. The mean serum creatinine and BUN were 1.2 ± 0.6 mg/dl and 26 ± 11 mg/dl; the calculated creatinine clearance was 75 ± 23 ml/min/1.73 m 2 . Twenty-four (62%) patients have been successfully withdrawn from steroids, and 24 (62%) require no anti-hypertensive medication. Improved growth was seen, particularly in pre-adolescent children off steroids.Between July 28, 1990, and December 2, 1993, 24 children were referred for rescue therapy with FK506, 14.6 ± 16.4 months (range 1.1-53.2) after transplantation. Nineteen (79%) were referred because of resistant rejection; 4 (17%) were referred because of proteinuria; 1 (4%) was switched because of steroid-related obesity. There were no deaths. One and two year graft survival was 75% and 68%. Seventeen (71%) patients were successfully rescued, including 1 of 2 patients who arrived on dialysis. Four (24%) of the successfully rescued patients were weaned off steroids.While not without side effects, which include nephrotoxicity, neurotoxicity, diabetogenicity, and viral complications, FK506 appears to be an effective immunosuppressive agent for both primary and rescue therapy after kidney transplantation. Its steroid-sparing qualities may be of particular importance in the pediatric population.

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FK506 in pediatric kidney transplantation—Primary and rescue experience

Shapiro

Scantlebury

Jordan

et al. 1995

Pediatr Nephrol

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Tacrolimus in Pediatric Renal Transplantation1

Shapiro¹,

Scantlebury²,

Jordan³

et al. 1996

Transplantation

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Pediatric Renal Transplantation Under Tacrolimus-Based Immunosuppression1

Shapiro¹,

Scantlebury²,

Jordan³

et al. 1999

Transplantation

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Background. Tacrolimus has been used as a primary immunosuppressive agent in adult and pediatric renal transplant recipients, with reasonable outcomes.Methods. Between December 14, 1989 and December 31, 1996, 82 pediatric renal transplantations alone were performed under tacrolimus-based immunosuppression without induction anti-lymphocyte antibody therapy. Patients undergoing concomitant or prior liver and/or intestinal transplantation were not included in the analysis. The mean recipient age was 10.6±5.2 years (range: 0.7-17.9). Eighteen (22%) cases were repeat transplantations, and 6 (7%) were in patients with panel-reactive antibody levels over 40%. Thirty-four (41%) cases were with living donors, and 48 (590/0) were with cadaveric donors. The mean donor age was 27.3±14.6 years (range: 0.7-50), and the mean cold ischemia time in the cadaveric cases was 26.5±8.8 hr. The mean number of lILA matches and mismatches was 2.8±1.2 and 2.9±1.3; there were five (6%) O-Ag mismatches. The mean follow-up was 4.0±0.2 years.Results. The 1-and 4-year actuarial patient survival was 99% and 94%. The 1-and 4-year actuarial graft survival was 98% and 84%. The mean serum creatinine was 1.1±O.5 mgldl, and the corresponding calculated creatinine clearance was 88±25 mJlminl1.73 m 2 • A total of 66% of successfully transplanted patients were withdrawn from prednisone. In children who were withdrawn from steroids, the mean standard deviation height scores (Z-score) at the time of transplantation and at 1 and 4 years were -2.3±2.0, -1.7±1.0, and +0.36±1.5. Eighty-six percent of successfully transplanted patients were not taking anti.hypertensive medications. The incidence of acute rejection was 44%;

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Pediatric renal transplantation under FK-506 immunosuppression

Cited by 5 publications

References 8 publications

FK506 in pediatric kidney transplantation—Primary and rescue experience

FK506 in pediatric kidney transplantation—Primary and rescue experience

Tacrolimus in Pediatric Renal Transplantation1

Pediatric Renal Transplantation Under Tacrolimus-Based Immunosuppression1

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