Low-dose cyclosporine therapy combined with standard immunosuppression in pediatric renal transplantation.
A new immunosuppressive regimen combining anti-lymphocyte globulin, azathioprine, prednisone, and low doses of cyclosporine was used in 28 children aged 9 months to 17 years (mean 5.8 years) who received primary renal allografts between July 1, 1984, and September 25, 1986. After a mean follow-up of 17.3 months, the patient and graft survival is 100% (18 of 18) for mismatched related kidneys, and 90% (nine of 10) for cadaver kidneys. The single graft failure was the result of a death from technical complications. Serum creatinine concentration after transplantation ranged from 0.3 to 1.7 mg/dL (mean 0.85 mg/dL). The probability of a rejection episode in the first year was 45% and 60% for mismatched-related and cadaver kidneys, respectively. Cyclosporine nephrotoxicity was recognized in only one (3.7%) of 27 children, and was rapidly reversed after cyclosporine was discontinued. An initial group of nine children was weaned from cyclosporine therapy 6 to 12 months after transplantation, but two (22%) had rejection episodes. Our preliminary experience suggests that the use of a quadruple immunosuppressive regimen for both living related and cadaver renal transplants in children is associated with an improved graft function rate and a low incidence of complications.
So
S K
SK
Department of Surgery, University of Minnesota Health Sciences Center, Minneapolis.
Najarian
J S
JS
Nevins
T E
TE
Fryd
D S
DS
Knaak
M
M
Chavers
B
B
Mauer
S M
SM
Simmons
R L
RL
D000293:Adolescent; D000961:Antilymphocyte Serum / Q000008:administration & dosage; D001379:Azathioprine / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D003524:Cyclosporins / Q000008:administration & dosage / Q000627:therapeutic use*; D005069:Evaluation Studies as Topic; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007223:Infant; D007677:Kidney Function Tests; D016030:Kidney Transplantation; D011183:Postoperative Complications; D011241:Prednisone / Q000008:administration & dosage
D000961:Antilymphocyte Serum; D003524:Cyclosporins; D007166:Immunosuppressive Agents; D001379:Azathioprine; D011241:Prednisone