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Four years' experience with cyclosporin A in pediatric kidney transplantation
P F Hoyer1, G Offner, B S Oemar
1Department of Pediatric Nephrology and Metabolic Disorders, Medical School Hannover, FRG.
Insights
Cyclosporin A (CsA) treatment in pediatric kidney transplant patients showed excellent graft survival rates and improved growth. However, CsA-associated nephrotoxicity and hypertension remain significant challenges requiring further management strategies.
Area of Science:
- Pediatric Nephrology
- Transplantation Immunology
- Pharmacology
Background:
- Kidney transplantation in children is a complex procedure.
- Immunosuppressive therapy is crucial for graft survival.
- Cyclosporin A (CsA) is a key immunosuppressant, but its long-term effects in pediatric populations require evaluation.
Purpose of the Study:
- To assess the efficacy and safety of Cyclosporin A and low-dose prednisolone in children undergoing kidney transplantation.
- To evaluate long-term graft and patient survival rates.
- To identify and analyze adverse effects, including nephrotoxicity and growth patterns.
Main Methods:
- A cohort of 63 children received CsA and low-dose prednisolone between 1982 and 1987 post-kidney transplantation.
- Dosage regimen for CsA was based on body surface area to achieve adequate blood levels.
- Patient and graft survival, glomerular filtration rate, blood pressure, uric acid levels, infection rates, and growth parameters were monitored.
Main Results:
- Excellent 4-year patient survival (98.3%) and living-related graft survival (100%).
- Cadaveric graft survival was 73%.
- Significant concerns included a decline in glomerular filtration rate (51.8 to 40.5 ml/min/1.73 m2), high hypertension rate (77.8%), and hyperuricemia. Mild CsA side effects and 11.1% infection rate were observed. Growth improved in both prepubertal (0.74 SD) and pubertal (0.51 SD) children.
Conclusions:
- Cyclosporin A treatment in children leads to excellent long-term graft survival and improved growth rehabilitation.
- Nephrotoxicity and hypertension associated with CsA remain major challenges in pediatric kidney transplant recipients.
- Further research is needed to mitigate CsA-induced renal complications and hypertension.
Abstract:
From 1982 to 1987 sixty-three children were treated with cyclosporin A and low dose prednisolone after kidney transplantation. Patient survival rate at 4 years after transplantation was 98.3%, survival rate of living related grafts 100% (n = 10), and survival rate of cadaveric grafts 73% (n = 53). Adequate cyclosporin blood levels were achieved in all children with a dosage regimen related to body surface area. Major concerns during the observation period were the loss of glomerular filtration rate from 51.8 to 40.5 ml/min/1.73 m2, a hypertension rate of 77.8%, and hyperuricemia. Cyclosporin A-side effects were mild. Infections occurred in 11.1%. Growth retardation in prepubertal children improved by 0.74 standard deviations of normal height, and in pubertal children by 0.51. We conclude that cyclosporin A treatment in children enables excellent long term graft survival rates with improved growth rehabilitation, however, the prevention of the cyclosporin associated nephrotoxicity and hypertension remains the major problem.