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Pediatric renal transplantation with mycophenolate mofetil-based immunosuppression without induction: results after
Therese Jungraithmayr1, Astrid Staskewitz, Günter Kirste
1Zentrum für Kinderheilkunde und Jugendmedizin, Freiburg, Germany.
Background:
Mycophenolate mofetil (MMF)-based immunosuppression has reduced the acute rejection rate in adults and in children in the early posttransplantation period. Three-year posttransplantation results have been reported for adults but not for children thus far. In the present open-labeled study, patients 18 years old and younger were evaluated prospectively for up to 3 years after renal transplantation (RTX).
Methods:
Eighty-six patients receiving MMF in combination with cyclosporine and prednisone without induction were evaluated for patient survival, transplant survival, renal function, arterial blood pressure, adverse events, and opportunistic infections. These patients were compared with a historic control group (n=54) receiving azathioprine (AZA) instead of MMF.
Results:
Patient survival after 3 years was 98.8% in the MMF group and 94.4% in the AZA group (NS). Intent-to-treat analysis of graft survival demonstrated superiority for MMF (98% vs. 80%; P<0.001). Cumulative acute rejection episodes occurred in 47% of patients in the MMF group versus 61% in the AZA group (P<0.05). Renal function was not significantly different, neither after 3 years nor in the long-term calculation. Antihypertensive medication was administered to 73% to 84% of patients, similar in both groups. Opportunistic infections were recorded only for MMF. Infection rates were comparable to those reported in adults.
Conclusions:
These results suggest that MMF is safe and beneficial as a longer term maintenance immunosuppressive drug in children and adolescents.
Insights
Mycophenolate mofetil (MMF) offers superior graft survival in pediatric renal transplant patients compared to azathioprine (AZA). This immunosuppressive drug is safe and effective for long-term use in children and adolescents post-transplant.
Area of Science:
- Pediatric Nephrology
- Transplantation Immunology
- Pharmacology
Background:
- Mycophenolate mofetil (MMF)-based immunosuppression is established for early post-renal transplantation (RTX) in adults and children.
- Long-term (3-year) RTX outcomes data are lacking for pediatric patients on MMF.
- This study prospectively evaluated pediatric RTX patients up to 3 years post-transplant.
Purpose of the Study:
- To assess the 3-year efficacy and safety of MMF in pediatric RTX.
- To compare MMF with azathioprine (AZA) in pediatric RTX outcomes.
Main Methods:
- An open-label study of 86 pediatric RTX patients (≤18 years) receiving MMF, cyclosporine, and prednisone.
- Evaluation included patient/graft survival, renal function, blood pressure, adverse events, and opportunistic infections.
- Comparison with a historic control group (n=54) on AZA instead of MMF.
Main Results:
- Three-year graft survival was significantly higher with MMF (98%) versus AZA (80%; P<0.001).
- Acute rejection episodes were lower in the MMF group (47%) compared to AZA (61%; P<0.05).
- Patient survival, renal function, and blood pressure were comparable between groups; opportunistic infections were noted in the MMF group but comparable to adult rates.
Conclusions:
- MMF demonstrates superior long-term graft survival and reduced acute rejection in pediatric RTX compared to AZA.
- MMF is a safe and beneficial maintenance immunosuppressant for children and adolescents undergoing renal transplantation.