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Early Postoperative Kidney Transplant Complications Related to Immunomodulator Regimen in Pediatric Recipients
Samileh Noorbakhsh1, Nahid Rahimzadeh, Rozita Hosseini
1From the Department of Pediatrics Infectious Disease, Hazrat Rasoul Akram Hospital, Iran University of Medical Sciences, Iran.
Insights
Pediatric kidney transplant patients on cyclosporine or tacrolimus showed similar rates of rejection and infection. These calcineurin inhibitors can be interchanged if needed for tolerability.
Area of Science:
- Nephrology
- Immunology
- Pediatric Medicine
Background:
- Calcineurin inhibitors like cyclosporine and tacrolimus are crucial for preventing acute rejection in kidney transplant recipients.
- However, their comparative effects on long-term graft health and early complications remain incompletely understood, particularly in pediatric populations.
Purpose of the Study:
- To compare early post-transplant complications, specifically graft rejection and infection rates, between pediatric patients receiving cyclosporine versus tacrolimus.
Main Methods:
- A prospective cohort study included 105 pediatric kidney transplant candidates (ages 4-18).
- Patients were assigned to receive either cyclosporine (n=28) or tacrolimus (n=77).
- Infections (cytomegalovirus, BK virus, bacterial) and graft rejection were monitored for one year; graft failure was also assessed.
Main Results:
- No significant differences were observed between the cyclosporine and tacrolimus groups regarding graft rejection rates, cytomegalovirus, BK virus, or bacterial infections.
- Graft failure occurred significantly more often in male patients compared to females (30.9% vs 8.2%).
- Previous graft failure history or donor infection history did not significantly impact post-transplant graft complications.
Conclusions:
- Both cyclosporine and tacrolimus demonstrate comparable outcomes concerning graft rejection and post-transplant infections in pediatric kidney transplant recipients.
- The choice between these calcineurin inhibitors can be based on tolerability, as they appear interchangeable for managing immunosuppression.
Objectives:
Calcineurin inhibitors (cyclosporine and tacrolimus) are widely used in kidney transplant to prevent acute transplantrejection; however,the effects of these medications on graft sequelae after transplant remain unclear. We aimed to compare early complications, including graftrejectionandinfectionrates after kidney transplant, in childrenbetween the cyclosporine and tacrolimus immunomodulator regimens.
Materials And Methods:
In this prospective cohort study, 105 pediatric patients who were candidates to receive kidney transplant in the age range of 4 to 18 years were included. There were 28 patients who received cyclosporine, and 77 patients who received tacrolimus. Participants were routinely tested for cytomegalovirus, BK virus, and bacterial infection on a monthly basis for the first 3 months and once every 3 months thereafter for the first year. The graft rejection rate was also assessed and compared between the 2 treatment regimens.
Results:
There were no significant differences between the 2 groups receiving cyclosporine or tacrolimus in graft rejection rate (P = .719), cytomegalovirus viremia (P = .112), BK viremia (P = .278), and bacterial infection (P = .897). Graftfailure was significantly more frequent in male than in female patients (30.9% vs 8.2%; P = .004). The rates of graft failure in study patients with and without previous history of graftfailure were found to be statistically similar (16.7% vs 20.4%; P = .825). History of infection in donors did not affect the graft complications posttransplant in recipients.
Conclusions:
The use of either tacrolimus or cyclosporine leads to similar consequences in terms of graft rejection or posttransplant viral and bacterial infection, so either drug may be exchanged for the other if needed for tolerability.
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