Improved long-term graft function in pediatric transplant renal recipients with chronic allograft nephropathy.
CAN is the leading cause of graft loss in pediatric renal transplant recipients. A retrospective single centre analysis of pediatric transplant patients with CAN treated with MMF in conjunction with CNI minimisation/withdrawal is reported. 35 children were successfully started on MMF. The mean age at transplant was 7.9 +/- 0.1 years. MMF was introduced 3.5 +/- 0.1 years after transplantation and patients were followed up for a mean of 32.2 +/- 0.5 months. CAN was confirmed on biopsy in 31 patients. CNI was stopped in 23 patients at a mean time of 16.5 +/- 0.6 months after MMF introduction and minimised in the remaining patients. Prior to MMF introduction, GFR was deteriorating by 21.6 +/- 0.07 ml/min/1.73 m(2)/yr. After MMF, there was an overall improvement in GFR of 4.0 +/- 0.03 ml/min/1.73 m(2)/yr. This was most marked in the first six months when the GFR improved by 20.8 +/- 0.06 ml/min/1.73 m(2)/day. Mean acute rejection episode rate prior to MMF was significantly reduced after MMF introduction. MMF was discontinued in a total of 4 patients due to adverse effects. CNI minimisation/withdrawal with MMF introduction is safe and leads to significant initial improvement with subsequent stabilisation of GFR and improved long term graft survival in pediatric renal transplant recipients with CAN.
Department of Paediatric Nephrology, Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK. lkerecuk@doctors.org.uk
Larissa
L
Kerecuk
Catherine
C
Horsfield
Judy
J
Taylor
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D007223:Infant; D007674:Kidney Diseases / Q000209:etiology* / Q000601:surgery; D016030:Kidney Transplantation / Q000009:adverse effects*; D011183:Postoperative Complications; D012189:Retrospective Studies; D014184:Transplantation, Homologous
D007166:Immunosuppressive Agents