Pediatric Renal Transplantation Under Tacrolimus-Based Immunosuppression1

Abstract

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calculated creatinine clearance was 88±25 mJlminl1.73 m 2 • A total of 66% of successfully transplanted patients were withdrawn from prednisone. In children who were withdrawn from steroids, the mean standard deviation height scores (Z-score) at the time of transplantation and at 1 and 4 years were -2.3±2.0, -1.7±1.0, and +0.36±1.5.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%;

Basiliximab induction improves the outcome of renal transplants in children and adolescents

“…The decrease in the incidence of AR from 63% to 23% at the University of Pittsburgh was attributed by the authors to the maintenance of tacrolimus levels at 20-25 ng/ml in the more recently transplanted patients during the first 2 weeks after transplantation [1,9,10]. In our study, the mean tacrolimus level at 1 week after transplantation was 13.0±4.0 ng/ml in the BG and 14.9±6.3 ng/ml in the N-BG.…”

“…Although tacrolimus has been used successfully for primary immunosuppression in children with renal transplants, its use at levels considered adequate resulted in serious side effects such as PTLD and PTDM [1,[12][13][14][15]. Basiliximab therefore was added to the regimen in order to decrease the side effects while obtaining efficient immunosuppression.…”

“…A single dose of tacrolimus 0.15 mg/kg was given orally before transplantation to all patients from the BG and one patient from the N-BG. Starting on the first postoperative day, all patients received tacrolimus 0.3 mg/kg divided every 12 h. Subsequent doses were adjusted to achieve whole blood trough levels (TDX, Abbott Laboratories), 20-25 ng/ml during the 1st week and 15-20 ng/ml during the 2nd week after transplantation [1,9,10]. Subsequent target levels were 10-15 ng/ml until the end of the 2nd month and 5-10 ng/ml thereafter.…”

“…In the most recent publication from the University of Pittsburgh, Shapiro et al describe the outcomes of 82 renal transplants [1]. The 1-and 4-year actuarial patient and graft survival rates were 99% and 94%, and 98% and 84%, respectively.…”

Outcome After Steroid Withdrawal in Adult Renal Transplant Patients Receiving Tacrolimus-Based Immunosuppression.

“…With the introduction of tacrolimus, however, steroid withdrawal has been possible in some 70% of successfully transplanted adults and children. [1][2][3][4][5][6][7][8] An important question, however, concerns the outcome after steroid withdrawal in adult patients on tacrolimus. We looked at our adult renal transplant patients receiving tacrolimus-based immunosuppression' and examined the short-and medium-term outcomes after steroid withdrawal.…”