title: Pediatric renal transplantation with mycophenolate mofetil-based immunosuppression without induction: results after three years.
abstract: BACKGROUND
  Mycophenolate mofetil (MMF)-based immunosuppression has reduced the acute rejection rate in adults and in children in the early posttransplantation period. Three-year posttransplantation results have been reported for adults but not for children thus far. In the present open-labeled study, patients 18 years old and younger were evaluated prospectively for up to 3 years after renal transplantation (RTX).
  
  
  METHODS
  Eighty-six patients receiving MMF in combination with cyclosporine and prednisone without induction were evaluated for patient survival, transplant survival, renal function, arterial blood pressure, adverse events, and opportunistic infections. These patients were compared with a historic control group (n=54) receiving azathioprine (AZA) instead of MMF.
  
  
  RESULTS
  Patient survival after 3 years was 98.8% in the MMF group and 94.4% in the AZA group (NS). Intent-to-treat analysis of graft survival demonstrated superiority for MMF (98% vs. 80%; P<0.001). Cumulative acute rejection episodes occurred in 47% of patients in the MMF group versus 61% in the AZA group (P<0.05). Renal function was not significantly different, neither after 3 years nor in the long-term calculation. Antihypertensive medication was administered to 73% to 84% of patients, similar in both groups. Opportunistic infections were recorded only for MMF. Infection rates were comparable to those reported in adults.
  
  
  CONCLUSIONS
  These results suggest that MMF is safe and beneficial as a longer term maintenance immunosuppressive drug in children and adolescents.
authors.affiliation: Zentrum für Kinderheilkunde und Jugendmedizin, Freiburg, Germany.
authors.forename: Therese
authors.initials: T
authors.lastname: Jungraithmayr
authors.forename: Astrid
authors.initials: A
authors.lastname: Staskewitz
authors.forename: Günter
authors.initials: G
authors.lastname: Kirste
authors.forename: Michael
authors.initials: M
authors.lastname: Böswald
authors.forename: Monika
authors.initials: M
authors.lastname: Bulla
authors.forename: Rainer
authors.initials: R
authors.lastname: Burghard
authors.forename: Jürgen
authors.initials: J
authors.lastname: Dippell
authors.forename: Christel
authors.initials: C
authors.lastname: Greiner
authors.forename: Udo
authors.initials: U
authors.lastname: Helmchen
authors.forename: Bernd
authors.initials: B
authors.lastname: Klare
authors.forename: Günter
authors.initials: G
authors.lastname: Klaus
authors.forename: Heinz E
authors.initials: HE
authors.lastname: Leichter
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Mihatsch
authors.forename: Dietrich V
authors.initials: DV
authors.lastname: Michalk
authors.forename: Joachim
authors.initials: J
authors.lastname: Misselwitz
authors.forename: Christian
authors.initials: C
authors.lastname: Plank
authors.forename: Uwe
authors.initials: U
authors.lastname: Querfeld
authors.forename: Lutz T
authors.initials: LT
authors.lastname: Weber
authors.forename: Manfred
authors.initials: M
authors.lastname: Wiesel
authors.forename: Burkhard
authors.initials: B
authors.lastname: Tönshoff
authors.forename: Lothar B
authors.initials: LB
authors.lastname: Zimmerhackl
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D001379:Azathioprine / Q000008:administration & dosage; D001794:Blood Pressure; D002648:Child; D016572:Cyclosporine / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000188:drug therapy* / Q000401:mortality; D006085:Graft Survival / Q000187:drug effects; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000628:therapy; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D007668:Kidney / Q000502:physiology; D016030:Kidney Transplantation; D008297:Male; D009173:Mycophenolic Acid / Q000008:administration & dosage* / Q000009:adverse effects / Q000031:analogs & derivatives; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine; D009173:Mycophenolic Acid; D001379:Azathioprine