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Tacrolimus in pediatric renal transplantation
R Shapiro1, V P Scantlebury, M L Jordan
1Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pennsylvania 15213, USA.
Transplantation
|December 27, 1996
Summary
Tacrolimus demonstrates excellent patient and graft survival in pediatric kidney transplants. This immunosuppressant allows steroid withdrawal in most children and shows decreasing complication rates with experience.
Area of Science:
- Nephrology
- Pediatric Transplantation
- Immunosuppression
Background:
- Pediatric renal transplantation requires effective immunosuppression to ensure graft survival and patient well-being.
- Tacrolimus (TAC) is a potent calcineurin inhibitor used in organ transplantation.
- Evaluating TAC's efficacy and safety in a pediatric cohort is crucial for optimizing post-transplant care.
Purpose of the Study:
- To assess the efficacy and safety of tacrolimus as the primary immunosuppressive agent in pediatric renal transplant recipients.
- To evaluate patient and graft survival rates, rejection incidence, and complication rates associated with tacrolimus-based immunosuppression.
- To determine the feasibility of steroid withdrawal and the impact on metabolic parameters in this population.
Main Methods:
- Retrospective analysis of 69 pediatric renal transplantations performed between December 1989 and June 1995.
- Tacrolimus was the primary immunosuppressant, combined with steroids and, in some cases, azathioprine.
- Patient and graft survival, rejection rates, delayed graft function, and incidence of viral infections and post-transplant lymphoproliferative disorder (PTLD) were recorded.
Main Results:
- Excellent 1- and 4-year actuarial patient survival (100% and 95%) and graft survival (99% and 85%) were observed.
- Tacrolimus enabled steroid withdrawal in 73% of successfully transplanted children, with good renal function (creatinine clearance 82 ml/min/1.73 m2).
- Rejection incidence decreased over time, and complications like new-onset diabetes (10.1%) and PTLD (10%) were manageable, with PTLD patients surviving with functioning grafts.
Conclusions:
- Tacrolimus is a superior immunosuppressive agent in pediatric renal transplantation, offering excellent short- and medium-term outcomes.
- The ability to withdraw steroids in the majority of patients is a significant advantage, improving quality of life.
- Increasing experience with tacrolimus is associated with a decreasing incidence of rejection and viral complications, highlighting its long-term potential.