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Quantification of the Immunosuppressant Tacrolimus on Dried Blood Spots Using LC-MS/MS
Published on: November 8, 2015
Immunosuppression minimization in pediatric transplantation
1Department of Pediatrics, Stanford University, Palo Alto, CA, USA. msarwal@stanford.edu
Summary
Minimizing immunosuppression in children undergoing renal transplantation may reduce patient morbidity by avoiding drug side effects. Further research is needed to confirm the safety and efficacy of steroid and calcineurin inhibitor minimization strategies.
Area of Science:
- Pediatric Nephrology
- Transplantation Immunology
- Pharmacology
Background:
- Immunosuppression is crucial after pediatric renal transplantation but carries significant side effects.
- Steroids and calcineurin inhibitors (CNIs) are associated with considerable patient morbidity.
- Minimizing these agents may improve outcomes in pediatric kidney transplant recipients.
Purpose of the Study:
- To review current strategies for immunosuppression minimization in pediatric renal transplantation.
- To discuss the risks and benefits associated with reducing steroid and CNI exposure.
- To highlight the need for further evidence on alternative immunosuppression regimens.
Main Methods:
- Review of published literature on steroid and CNI minimization in pediatric renal transplantation.
- Analysis of data from uncontrolled trials and ongoing randomized controlled trials.
- Discussion of pharmacokinetic and mechanistic studies.
Main Results:
- Steroid minimization/avoidance shows early promise in uncontrolled trials.
- CNI minimization with mycophenolate mofetil or sirolimus has yielded variable renal function improvements.
- Suboptimal efficacy and safety have limited current CNI minimization regimens.
- Newer immunosuppressants offer options for selected minimization strategies.
Conclusions:
- Immunosuppression minimization in pediatric renal transplantation may improve patient and graft morbidity.
- Randomized trials are essential to confirm the long-term safety and efficacy of alternative immunosuppression combinations.
- Optimizing drug dosing and monitoring through pharmacokinetic studies is warranted.
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