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Quantification of the Immunosuppressant Tacrolimus on Dried Blood Spots Using LC-MS/MS
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Prevalence of renal dysfunction in tacrolimus-treated pediatric transplant recipients: a systematic review

Violette M G J Gijsen1, Dennis A Hesselink, Kenneth Croes

  • 1Intensive Care and Department of Pediatric Surgery, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands.

Pediatric Transplantation
|March 2, 2013
PubMed

Insights

Pediatric non-renal transplant patients treated with tacrolimus show a high prevalence of chronic kidney disease. Further research is needed to understand risk factors and personalize immunosuppression for these children.

Area of Science:

  • Pediatric Nephrology
  • Transplant Immunology
  • Pharmacology

Background:

  • Tacrolimus is a common immunosuppressant after transplantation.
  • Renal dysfunction is a known complication in adult transplant recipients.
  • Data on renal dysfunction in pediatric non-renal transplant recipients is limited.

Purpose of the Study:

  • To systematically review the literature on the prevalence of renal dysfunction in children undergoing non-renal transplantation and treated with tacrolimus.
  • To assess the range of reported chronic kidney disease prevalence in pediatric liver and heart/lung transplant recipients.

Main Methods:

  • Systematic literature search of PubMed/Medline, Embase, and Google up to April 19, 2012.
  • Inclusion of studies on pediatric non-renal transplant recipients treated with tacrolimus.
  • Analysis of reported prevalences of mild and severe chronic kidney disease.

Main Results:

  • Eighteen relevant studies were identified, focusing on liver, heart, and intestinal transplant recipients.
  • Prevalence of mild chronic kidney disease ranged from 0% to 39% (liver) and 22.7% to 40% (heart/lung).
  • Prevalence of severe chronic kidney disease ranged from 0% to 71.4% (liver) and 6.8% to 46% (heart/lung).

Conclusions:

  • A significant proportion of pediatric non-renal transplant patients on tacrolimus experience chronic kidney disease.
  • Wide ranges in reported prevalence suggest potential inclusion bias and varying definitions of renal dysfunction.
  • Further research is warranted to determine actual risks, identify risk factors, and individualize tacrolimus therapy.

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