Details
| Original language | English |
|---|---|
| Pages (from-to) | 658-662 |
| Number of pages | 5 |
| Journal | Transplantation |
| Volume | 92 |
| Issue number | 6 |
| Publication status | Published - 27 Sept 2011 |
| Externally published | Yes |
Abstract
Background. Acute rejections and infections continue to cause substantial problems for pediatric kidney transplant (KTX) patients because defining an immunosuppressive protocol capable of preventing both has been challenging. Previously, we initiated a prospective trial to evaluate an immunosuppressive regimen designed to achieve this goal. Herein, we present the results of the 3-year follow-up of this trial. Methods. After KTX, 20 children (median age 12 years, range 1-17 years) received basiliximab, cyclosporine A (CsA) (trough-level=C0 200-250 ng/mL), and prednisolone. Two weeks post-KTX, everolimus (1.6 mg/m/day) treatment was started (C0 4-6 ng/mL), and the CsA dose was reduced by 50% (C0 75-100 ng/mL, after 6 months: C0 50-75 ng/mL). Prednisolone treatment was gradually withdrawn and was completely stopped at 9 months post-KTX. Results. There was no loss of follow-up and no graft or patient loss during the 3-year period. Indication biopsies showed no acute rejection (Banff IA). One of the patients had signs of chronic humoral rejection. Mean glomerular filtration rate measured at 1 year and 3 years post-KTX was 71±25 and 61±27 mL/min/1.73 m, respectively. In patients transitioned to adult care, mean glomerular filtration rate at 3 years was 49±13 mL/min/1.73 m (P<0.05). No cases of posttransplant lymphoproliferative disorder posttransplant lymphoproliferative disorder or polyoma nephropathy were diagnosed. After 3 years, 17 of 20 patients remained on the original immunosuppressive regimen. Conclusions. A treatment regimen consisting of de novo immunosuppression with basiliximab, CsA, and prednisolone, followed by treatment with everolimus and low-dose CsA combined with steroid withdrawal may be a promising therapy after pediatric KTX.
Keywords
- Acute rejection, Children, Everolimus, Kidney transplantation
ASJC Scopus subject areas
- Medicine(all)
- Transplantation
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In: Transplantation, Vol. 92, No. 6, 27.09.2011, p. 658-662.
Research output: Contribution to journal › Article › Research › peer review
}
TY - JOUR
T1 - Pediatric kidney transplantation followed by de novo therapy with everolimus, low-dose cyclosporine a, and steroid elimination
T2 - 3-Year Data
AU - Pape, Lars
AU - Lehner, Frank
AU - Blume, Cornelia
AU - Ahlenstiel, Thurid
PY - 2011/9/27
Y1 - 2011/9/27
N2 - Background. Acute rejections and infections continue to cause substantial problems for pediatric kidney transplant (KTX) patients because defining an immunosuppressive protocol capable of preventing both has been challenging. Previously, we initiated a prospective trial to evaluate an immunosuppressive regimen designed to achieve this goal. Herein, we present the results of the 3-year follow-up of this trial. Methods. After KTX, 20 children (median age 12 years, range 1-17 years) received basiliximab, cyclosporine A (CsA) (trough-level=C0 200-250 ng/mL), and prednisolone. Two weeks post-KTX, everolimus (1.6 mg/m/day) treatment was started (C0 4-6 ng/mL), and the CsA dose was reduced by 50% (C0 75-100 ng/mL, after 6 months: C0 50-75 ng/mL). Prednisolone treatment was gradually withdrawn and was completely stopped at 9 months post-KTX. Results. There was no loss of follow-up and no graft or patient loss during the 3-year period. Indication biopsies showed no acute rejection (Banff IA). One of the patients had signs of chronic humoral rejection. Mean glomerular filtration rate measured at 1 year and 3 years post-KTX was 71±25 and 61±27 mL/min/1.73 m, respectively. In patients transitioned to adult care, mean glomerular filtration rate at 3 years was 49±13 mL/min/1.73 m (P<0.05). No cases of posttransplant lymphoproliferative disorder posttransplant lymphoproliferative disorder or polyoma nephropathy were diagnosed. After 3 years, 17 of 20 patients remained on the original immunosuppressive regimen. Conclusions. A treatment regimen consisting of de novo immunosuppression with basiliximab, CsA, and prednisolone, followed by treatment with everolimus and low-dose CsA combined with steroid withdrawal may be a promising therapy after pediatric KTX.
AB - Background. Acute rejections and infections continue to cause substantial problems for pediatric kidney transplant (KTX) patients because defining an immunosuppressive protocol capable of preventing both has been challenging. Previously, we initiated a prospective trial to evaluate an immunosuppressive regimen designed to achieve this goal. Herein, we present the results of the 3-year follow-up of this trial. Methods. After KTX, 20 children (median age 12 years, range 1-17 years) received basiliximab, cyclosporine A (CsA) (trough-level=C0 200-250 ng/mL), and prednisolone. Two weeks post-KTX, everolimus (1.6 mg/m/day) treatment was started (C0 4-6 ng/mL), and the CsA dose was reduced by 50% (C0 75-100 ng/mL, after 6 months: C0 50-75 ng/mL). Prednisolone treatment was gradually withdrawn and was completely stopped at 9 months post-KTX. Results. There was no loss of follow-up and no graft or patient loss during the 3-year period. Indication biopsies showed no acute rejection (Banff IA). One of the patients had signs of chronic humoral rejection. Mean glomerular filtration rate measured at 1 year and 3 years post-KTX was 71±25 and 61±27 mL/min/1.73 m, respectively. In patients transitioned to adult care, mean glomerular filtration rate at 3 years was 49±13 mL/min/1.73 m (P<0.05). No cases of posttransplant lymphoproliferative disorder posttransplant lymphoproliferative disorder or polyoma nephropathy were diagnosed. After 3 years, 17 of 20 patients remained on the original immunosuppressive regimen. Conclusions. A treatment regimen consisting of de novo immunosuppression with basiliximab, CsA, and prednisolone, followed by treatment with everolimus and low-dose CsA combined with steroid withdrawal may be a promising therapy after pediatric KTX.
KW - Acute rejection
KW - Children
KW - Everolimus
KW - Kidney transplantation
UR - http://www.scopus.com/inward/record.url?scp=80052648009&partnerID=8YFLogxK
U2 - 10.1097/TP.0b013e3182295bed
DO - 10.1097/TP.0b013e3182295bed
M3 - Article
C2 - 21804444
AN - SCOPUS:80052648009
VL - 92
SP - 658
EP - 662
JO - Transplantation
JF - Transplantation
SN - 0041-1337
IS - 6
ER -