[Controversies about the use of calcineurin inhibitors in pediatric patients].
The availability of new drugs has prompted transplant physicians to devise new immunosuppressive protocols without the calcineurin inhibitors cyclosporine and tacrolimus in order to reduce the incidence of their side effects, particularly nephrotoxicity. However, recent data suggest that these drugs still procure the longest organ survival after transplant. In addition, although they have been used for a long time, it is not clear which calcineurin inhibitor is to be preferred: tacrolimus seems most effective in reducing the acute rejection rate, possibly associated with a better glomerular filtration rate in the following years, but its benefit in the long run is not definitely established. It may allow a dose reduction of steroids, which is of particular interest in pediatric age, but it is associated with a higher incidence of severe side effects, in particular post-transplant lymphoproliferative disorders and diabetes. In recent protocols, the reduction of the dose of this drug has led to a reduction of these side effects, even though they are still more frequent than side effects observed during cyclosporine treatment.
Dello Strologo
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Dipartimento Nefrologia urologia, Ospedale Pediatrico Bambino Gesù, Istituto di Ricerca Scientifica, Piazza S. Onofrio 4, Rome, Italy. dellostrologo@opbg.net
D065095:Calcineurin Inhibitors; D002648:Child; D002675:Child, Preschool; D016572:Cyclosporine / Q000009:adverse effects / Q000627:therapeutic use*; D003920:Diabetes Mellitus / Q000209:etiology; D004359:Drug Therapy, Combination; D006084:Graft Rejection / Q000517:prevention & control*; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D007668:Kidney / Q000187:drug effects; D016030:Kidney Transplantation / Q000009:adverse effects; D008232:Lymphoproliferative Disorders / Q000209:etiology; D016559:Tacrolimus / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D016896:Treatment Outcome; D014661:Vasoconstriction / Q000187:drug effects
D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D016559:Tacrolimus