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Low-dose cyclosporin A therapy in cadaver renal transplantation in children
H Ruder1, J Strehlau, F Schaefer
1Division of Pediatric Nephrology, University Hospital, Heidelberg, Federal Republic of Germany.
Insights
Low-dose cyclosporine A (CyA) in pediatric kidney transplants shows comparable graft survival, renal function, and growth to azathioprine (AZA). This suggests CyA is a viable alternative for immunosuppression in young transplant recipients.
Area of Science:
- Pediatric Nephrology
- Transplantation Immunology
- Immunosuppression Therapy
Background:
- Pediatric kidney transplantation requires effective immunosuppression to ensure graft survival.
- Azathioprine (AZA) and cyclosporine A (CyA) are common immunosuppressants.
- Optimizing immunosuppression in children is crucial for long-term outcomes.
Purpose of the Study:
- To compare the efficacy and safety of low-dose cyclosporine A (CyA) versus azathioprine (AZA) in pediatric cadaveric kidney transplantation.
- To evaluate graft survival, renal function, and linear growth in pediatric kidney transplant recipients on different immunosuppressive regimens.
Main Methods:
- A cohort of 51 pediatric patients undergoing first cadaveric kidney transplantation was followed for at least 2 years.
- Patients were divided into two groups: methylprednisolone + AZA, and methylprednisolone + low-dose CyA.
- Graft survival, renal function (creatinine clearance), and linear growth were assessed over time.
Main Results:
- The 4-year graft survival rate was 78% for the CyA group and 68% for the AZA group.
- No significant differences in renal function were observed between the AZA and CyA groups at 1, 2, and 3 years post-transplant.
- Linear growth was comparable in both treatment groups.
Conclusions:
- Low-dose CyA immunosuppression demonstrates comparable outcomes to AZA in pediatric kidney transplantation regarding graft survival, renal function, and growth.
- Low-dose CyA is a viable immunosuppressive option for pediatric kidney transplant recipients.
- Further research may explore long-term benefits and potential side effects of low-dose CyA in this population.
Abstract:
Fifty-one pediatric patients undergoing a first cadaveric kidney transplantation were followed for at least 2 years after grafting. They were divided into two groups: those treated with methylprednisolone plus azathioprine (AZA) and those treated with methylprednisolone plus low-dose cyclosporin A (CyA; median dose 109 mg/m2 per day = 3.4 mg/kg per day after 1 year). The steroid dosage given was significantly lower in the second group. The 4-year graft survival rate was 68% for the AZA group and 78% for the CyA group. Renal function did not differ significantly in the two groups; after 1, 2, and 3 years, the median 24-h creatinine clearance was 79, 69, and 51 ml/min/1.73 m2, respectively, for the AZA group and 78, 63, and 68 ml/min/1.73 m2, respectively, for the CyA group. Linear growth was similar in the two groups. We conclude that in pediatric patients the results of low-dose CyA immunosuppression do not differ significantly from those obtained with AZA in terms of graft survival, renal function, or growth.