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FK506 in pediatric kidney transplantation--primary and rescue experience
R Shapiro1, V P Scantlebury, M L Jordan
1Department of Surgery, University of Pittsburgh Health Science Center, PA 15213, USA.
Insights
FK506 (tacrolimus) shows excellent graft survival rates in pediatric kidney transplant patients, allowing many to discontinue steroids and antihypertensive medications. This immunosuppressant also proves effective as rescue therapy for resistant rejection post-transplant.
Area of Science:
- Pediatric Nephrology
- Transplant Immunology
- Immunosuppressive Therapy
Background:
- Kidney transplantation is a vital treatment for pediatric end-stage renal disease.
- Effective immunosuppression is crucial for long-term graft survival and patient outcomes.
- Steroid-based immunosuppression is associated with significant side effects in children.
Purpose of the Study:
- To evaluate the efficacy and safety of FK506 (tacrolimus) as primary immunosuppression in pediatric kidney transplant recipients.
- To assess the utility of FK506 as rescue therapy for children experiencing refractory rejection or other complications after transplantation.
Main Methods:
- Retrospective analysis of 43 pediatric kidney transplant patients receiving FK506 as primary immunosuppression.
- Analysis of 24 pediatric patients receiving FK506 as rescue therapy for post-transplant complications.
- Evaluation of graft survival, renal function, and adverse effects, including steroid withdrawal and growth.
Main Results:
- Primary FK506 use resulted in high 1- and 3-year actuarial graft survival (98% and 85%).
- 62% of patients on primary FK506 were successfully withdrawn from steroids, and 62% required no antihypertensive medication.
- FK506 rescue therapy achieved 1- and 2-year graft survival of 75% and 68%, with 71% of patients successfully rescued.
Conclusions:
- FK506 is a safe and effective primary immunosuppressant in pediatric kidney transplantation, improving graft survival and reducing steroid dependence.
- FK506 serves as a valuable rescue therapy option for pediatric kidney transplant recipients with resistant rejection or other adverse outcomes.
- Improved growth was observed in pre-adolescent children successfully weaned off steroids.
Abstract:
Between 14 December 1989 and 17 December 1993, 43 patients undergoing kidney transplantation alone at the Children's Hospital of Pittsburgh received FK506 as the primary immunosuppressive agent. The mean recipient age was 10.2 +/- 4.8 years (range 0.7-17.4 years), with 7 (16%) children under 5 years of age and 2 (5%) under 2 years of age. Fifteen (35%) children underwent retransplantation, and 5 (12%) had a panel-reactive antibody level greater than 40%. Twenty-two (51%) transplants were with cadaveric donors and 21 (49%) were with living donors. The mean follow-up was 25 +/- 14 months; there were no deaths; 1- and 3-year actuarial graft survival was 98% and 85%. The mean serum creatinine and blood urea nitrogen were 1.2 +/- 0.6 mg/dl and 26 +/- 11 mg/dl; the calculated creatinine clearance was 75 +/- 23 ml/min per 1.73 m2. Twenty-four (62%) patients have been successfully withdrawn from steroids and 24 (62%) require no anti-hypertensive medication. Improved growth was seen, particularly in pre-adolescent children off steroids. Between 28 July 1990 and 2 December 1993, 24 children were referred for rescue therapy with FK506, 14.6 +/- 16.4 months (range 1.1-53.2 months) after transplantation. Nineteen (79%) were referred because of resistant rejection; 4 (17%) were referred because of proteinuria; 1 (4%) was switched because of steroid-related obesity. There were no deaths; 1- and 2-year graft survival was 75% and 68%; 17 (71%) patients were successfully rescued, including 1 of 2 patients who arrived on dialysis; 4 (24%) of the successfully rescued patients were weaned off steroids.(ABSTRACT TRUNCATED AT 250 WORDS)