Comparison of FK-506 and cyclosporine regimens in pediatric renal transplantation.
Clinical aspects of FK-506 or cyclosporine immunosuppression regimens were evaluated in 48 consecutive pediatric renal transplant recipients. Tapering and discontinuation of prednisone was employed only in children receiving FK-506 who experienced minor or no rejection episodes during the 1st posttransplant month. At 1 year follow-up, 17 of 22 (77%) of all children with functioning allografts were receiving no prednisone (n = 13) or a mean dosage of 0.07 mg/kg per day (n = 4). During the 1st month, acute cellular rejection was more common in the FK-506 group (0.58 vs. 0.21 rejections per patient, P < 0.05) but allograft survival (92%) and renal function at 1 year posttransplant were identical in both groups. Compared with the cyclosporine regimen, FK-506 immunosuppression may be associated with a higher incidence of cytomegalovirus or reversible Epstein-Barr virus-induced lymphoproliferative disease. However, the FK-506 group had less hirsutism and gingival hypertrophy and required fewer antihypertensive medications independent of steroid use. Height standard deviation scores and weight-for-height index improved only in pre-adolescents receiving FK-506 but no prednisone (P < 0.02 and P < 0.05, respectively), but did not differ between children on FK-506 plus prednisone and those in the cyclosporine group. We conclude that the major advantages of FK-506 over cyclosporine immunosuppression are a reduced severity of hypertension and an improved cosmetic appearance which may improve long-term medical compliance. When used as monotherapy, FK-506 also shows promise in relieving the growth retardation associated with cyclosporine regimens that include prednisone.
Ellis
D
D
Children's Hospital of Pittsburgh, Division of Pediatric Nephrology, PA 15213.
Shapiro
R
R
Jordan
M L
ML
Scantlebury
V P
VP
Gilboa
N
N
Hopp
L
L
Weichler
N
N
Tzakis
A G
AG
Simmons
R L
RL
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D016572:Cyclosporine / Q000008:administration & dosage / Q000627:therapeutic use*; D004341:Drug Evaluation; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000188:drug therapy*; D006085:Graft Survival; D006128:Growth / Q000187:drug effects; D006801:Humans; D006973:Hypertension / Q000188:drug therapy; D007223:Infant; D007668:Kidney / Q000187:drug effects* / Q000502:physiology; D016030:Kidney Transplantation; D008297:Male; D016559:Tacrolimus / Q000008:administration & dosage / Q000627:therapeutic use*
D016572:Cyclosporine; D016559:Tacrolimus