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Pediatric renal transplantation under FK-506 immunosuppression
F X Schneck1, M L Jordan, C W Jensen
1Department of Surgery, University of Pittsburgh School of Medicine, Pennsylvania.
Insights
Pediatric kidney transplant patients showed excellent outcomes with FK-506 (tacrolimus) immunosuppression, achieving 100% patient survival and 92% graft survival. This regimen may allow for reduced steroid use, which is highly desirable in children.
Area of Science:
- Nephrology
- Immunosuppression
- Pediatric Transplantation
Background:
- Pediatric renal transplantation is crucial for end-stage renal disease.
- Steroid-based immunosuppression poses significant long-term risks for children.
- FK-506 (tacrolimus) offers an alternative immunosuppressive strategy.
Purpose of the Study:
- To evaluate the efficacy and safety of FK-506 combined with prednisone in pediatric kidney transplant recipients.
- To assess patient and graft survival rates.
- To determine the feasibility of reducing or eliminating steroid therapy.
Main Methods:
- Retrospective analysis of 12 pediatric patients undergoing renal transplantation.
- Immunosuppression regimen included FK-506 and varying doses of prednisone.
- Follow-up included monitoring graft function (serum creatinine, BUN) and clinical outcomes.
Main Results:
- High patient (100%) and graft (92%) survival rates at mean 6.1 months follow-up.
- One graft loss due to recurrent hemolytic uremic syndrome.
- Rejection episodes (8 in 5 patients) were successfully treated; complications included seizures, CMV infection, and steroid-induced diabetes.
Conclusions:
- FK-506-based immunosuppression demonstrates promising results in pediatric kidney transplantation.
- The regimen facilitates significant reduction or elimination of prednisone, minimizing steroid-related side effects.
- FK-506 is a potentially suitable immunosuppressant for pediatric renal transplant recipients.
Abstract:
Renal transplantation (11 cadaveric and 1 living-related donor) was performed in 12 pediatric recipients (mean age 10.8 years) under FK-506 immunosuppression in combination with prednisone therapy. At a mean followup of 6.1 months, patient and graft survival rates were 100% and 92%, respectively. The only graft loss was due to the recurrent hemolytic uremic syndrome 4 days after transplantation. In the functioning grafts the mean serum creatinine is 1.59 +/- 1.27 mg./dl. and the mean blood urea nitrogen is 36.3 +/- 24.6 mg./dl. Three patients take no prednisone, 5 are receiving 0.15 to 0.25 mg./kg. per day and 3 are taking 0.35 to 0.5 mg./kg. per day. There was a total of 8 rejection episodes in 5 patients. All rejection episodes were successfully reversed. Complications of transplantation included an episode of seizures in 1 patient, cytomegalovirus infection in 1 and steroid-induced diabetes mellitus in 1. Since pediatric transplant recipients are a group in whom the reduction or elimination of steroids is highly desirable, FK-506 immunosuppression may be particularly suited for use in this population.