Pediatric renal transplants--results with sequential immunosuppression.

Area of Science:

• Nephrology
• Immunosuppression Therapy
• Pediatric Transplantation

Background:

• Cyclosporine (CsA) has revolutionized renal transplantation outcomes.
• Sequential immunosuppression protocols, including CsA, were implemented in pediatric renal transplant recipients starting in 1984.

Purpose of the Study:

• To evaluate the outcomes of pediatric renal transplants using a sequential immunosuppression protocol involving Cyclosporine (CsA).
• To compare these outcomes with historical data from transplants performed without CsA.

Main Methods:

• A retrospective study of 131 pediatric renal transplants (age ≤ 18) performed between June 1984 and March 1991 using sequential immunosuppression (MALG, AZA, P, delayed CsA).
• Comparison with 144 pediatric renal transplants performed since January 1980 without CsA.
• Analysis of graft survival, patient survival, hospital readmissions, rejection episodes, and serum creatinine levels.

Main Results:

• The sequential immunosuppression group showed a 1-year actuarial graft survival of 93% and 100% patient survival.
• Compared to the non-CsA group (82% graft survival, 94% patient survival), sequential immunosuppression significantly improved patient (P = 0.003) and graft survival (P = 0.004).
• No significant differences were observed in readmissions, rejection episodes, or serum creatinine levels between the two groups.

Conclusions:

• Sequential immunosuppression with Cyclosporine (CsA) significantly enhances patient and graft survival in pediatric renal transplantation.
• While CsA improved survival rates, it did not significantly alter readmission rates, rejection episodes, or renal function compared to non-CsA protocols.
• Living donor recipients experienced fewer rejection episodes than cadaveric recipients in the CsA group.