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Cyclosporine in pediatric kidney transplantation

L Pape1, J H H Ehrich, G Offner

  • 1Department of Pediatric Nephrology, Medical School of Hannover, Hannover, Germany. larspape@t-online.de

Transplantation Proceedings
|March 26, 2004
PubMed

Insights

Cyclosporine (CsA) significantly improved pediatric kidney transplant outcomes, reducing rejection and enhancing graft survival. CsA-based immunosuppression also improved child growth rates compared to older methods.

Area of Science:

  • Pediatric Nephrology
  • Transplantation Immunology
  • Pharmacology

Background:

  • Pre-cyclosporine (CsA) era immunosuppression (azathioprine, steroids) led to high rejection rates and growth retardation in pediatric renal transplant recipients.
  • Early 1980s: Introduction of CsA for pediatric immunosuppression necessitated specialized dosing and monitoring due to metabolic differences.

Purpose of the Study:

  • To evaluate the impact of cyclosporine (CsA) on pediatric renal transplant outcomes, including rejection rates, graft survival, and growth.
  • To review the evolution of CsA formulations and monitoring strategies in pediatric transplantation.

Main Methods:

  • Review of historical data and clinical practice regarding CsA use in pediatric renal transplantation.
  • Analysis of outcomes related to CsA dosing, monitoring, and combination therapies.

Main Results:

  • CsA use decreased acute rejections and increased graft survival rates.
  • CsA-based regimens improved pediatric growth rates, attributed to reduced steroid co-administration.
  • CsA microemulsion (1990s) improved absorption and reduced variability, further enhancing outcomes. Common side effects include nephrotoxicity and hirsutism.

Conclusions:

  • Cyclosporine has been pivotal in improving pediatric renal transplant success, balancing efficacy with manageable side effects.
  • Advanced CsA formulations, targeted monitoring (2-hour postdose levels), and combination therapies (antibody induction, mycophenolate mofetil, ToR inhibitors) continue to refine outcomes and mitigate toxicity.

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