Decreased incidence of acute rejection in adolescent kidney transplant recipients using antithymocyte induction and triple immunosuppression.
BACKGROUND
Acute rejection is a frequent event in pediatric renal transplantation; it can diminish allograft function and affect long-term outcome. Recent data from the North American Pediatric Renal Transplant Cooperative Study indicates that the rate of acute rejection remains high despite current immunosuppressive regimens.


METHODS
In this retrospective series, we examined 37 pediatric renal transplant recipients who received induction doses of antithymocyte globulin combined with maintenance immunotherapy using tacrolimus, mycophenolate mofetil, and prednisone. The postoperative course was reviewed for initial and total hospital stay, number of rehospitalizations, evidence of posttransplant complications, graft fibrosis, and overall patient and graft survival.


RESULTS
Three episodes of acute rejection (8.1%) were recorded in the first year posttransplant. The median initial hospital stay for patients receiving a kidney transplant was 8 days. Patient and graft survival were 100% and 91.9% at 1 year, respectively. The incidence of viral infection (cytomegalovirus, BK virus, and Epstein-Barr virus) and posttransplant lymphoproliferative disease remained low. Urinary tract infection and fluid and electrolyte complications were the main causes of posttransplant hospitalization.


CONCLUSIONS
We conclude that induction with antithymocyte globulin and maintenance immunosuppression with tacrolimus, mycophenolate, and prednisone should be considered a valuable tool in the management of children undergoing renal transplantation.
Schwartz
Jason J
JJ
Department of Surgery, Division of General Surgery, Section of Transplant Surgery, School of Medicine, University of Utah, Salt Lake City, UT 84132, USA. jason.schwartz@hsc.utah.edu
Ishitani
Michael B
MB
Weckwerth
Jody
J
Morgenstern
Bruce
B
Milliner
Dawn
D
Stegall
Mark D
MD
D000293:Adolescent; D000961:Antilymphocyte Serum / Q000627:therapeutic use*; D001706:Biopsy; D002648:Child; D004359:Drug Therapy, Combination; D005260:Female; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D006085:Graft Survival; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007483:Iothalamic Acid / Q000493:pharmacokinetics; D016030:Kidney Transplantation; D007902:Length of Stay; D008297:Male; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D011241:Prednisone / Q000627:therapeutic use; D012189:Retrospective Studies; D016559:Tacrolimus / Q000627:therapeutic use
D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents; D007483:Iothalamic Acid; D009173:Mycophenolic Acid; D011241:Prednisone; D016559:Tacrolimus