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Use of cyclosporine in pediatric renal transplant recipients
Insights
This study shows that combining cyclosporine and prednisone is a safe and effective immunosuppressive regimen for pediatric kidney transplant recipients, achieving high patient and graft survival rates with minimal side effects.
Area of Science:
- Pediatric Nephrology
- Transplantation Immunology
- Immunosuppression Therapy
Background:
- Pediatric renal transplantation requires effective immunosuppression to prevent graft rejection.
- Optimizing immunosuppressive regimens is crucial for long-term graft survival and patient outcomes in children.
Purpose of the Study:
- To evaluate the efficacy and safety of a combined cyclosporine and prednisone immunosuppressive regimen in pediatric renal allograft recipients.
Main Methods:
- A cohort of 18 pediatric patients received renal allografts (cadaveric or living related).
- Immunosuppression was achieved using a combination of cyclosporine and prednisone.
- Patient and graft survival, renal function, rejection episodes, infections, and growth were monitored.
Main Results:
- 100% patient survival (18/18) and 83% graft survival (15/18) at a mean follow-up of 16.5 months.
- Mean serum creatinine was 1.22 mg/dl, with no irreversible cyclosporine nephrotoxicity.
- Low incidence of rejection (39%), hospital readmissions (39%), and no opportunistic infections observed.
Conclusions:
- Cyclosporine and prednisone provide a safe and effective immunosuppressive strategy for pediatric kidney transplant recipients.
- The regimen demonstrates favorable graft survival and renal function with manageable side effects.
- Further long-term follow-up is needed to confirm sustained benefits beyond two years.
Abstract:
Cyclosporine and prednisone were used in combination to produce immunosuppression in 18 pediatric recipients of renal allografts. Ten children received cadaveric kidneys and eight received kidneys from living related donors. With a mean follow-up of 16.5 months (range 7 to 33 months), the patient survival rate is 100% (18 of 18) and the graft survival rate is 83% (15 of 18). Two grafts were lost for nonimmunologic reasons. Currently the group mean (+/- SE) serum creatinine concentration is 1.22 +/- 0.11 mg/dl and creatinine clearance is 69.3 +/- 4.79 ml/min/1.73 m2. Cyclosporine nephrotoxicity has not caused irreversible allograft injury nor led to graft loss in this population. The incidence of treated rejection episodes has been 39% (seven of 18). Only 39% (seven of 18) of children have required hospital readmissions since the initial transplant discharge. There have been no opportunistic infections. In the 15 children with functioning grafts, some linear growth has occurred in 10 of 11 prepubertal and two of four postpubertal patients. Cyclosporine and prednisone have constituted a safe, efficacious immunosuppressive regimen for pediatric renal allograft recipients. Longer follow-up will be necessary to confirm whether these advantages persist beyond 2 years.