Recovery of graft function in pediatric kidney transplantation is not affected by delayed introduction of cyclosporine.
BACKGROUND
Delayed graft function and acute rejections adversely affect the long-term survival of kidney transplantation. To decrease the incidences of these phenomena, we changed the initial immunosuppressive protocol in pediatric kidney transplantation in The Netherlands.


METHODS
We compared a cohort (n=123) treated with basiliximab and delayed onset cyclosporine (CsA) with the preceding cohort (n=110) in which CsA was started already preoperatively. Both cohorts were treated with mycophenolate mofetil and corticosteroids as well. All consecutive transplantations were included.


RESULTS
The incidence of delayed graft function did not significantly differ between the cohorts (10% and 13%, in basiliximab and control group). Significantly fewer patients in the basiliximab group had acute rejection episodes (20% vs. 36% in control group, P=0.007). The mean estimated glomerular filtration rate at 1 year and graft survival at 2 years posttransplant did not differ between groups (62 vs. 64 mL/min 1.73 m2, and 89% vs. 92%, respectively).


CONCLUSIONS
Postponed onset of CsA in triple immunosuppressive therapy (corticosteroids, CsA, and mycophenolate mofetil) with addition of basiliximab did not reduce the incidence of delayed graft function in pediatric kidney transplantation. Yet, fewer acute rejections were noted. Long-term favorable effects could not be detected in this study.
Cransberg
Karlien
K
Department of Pediatric Nephrology, Erasmus MC Sophia, Rotterdam, The Netherlands. k.cransberg@erasmusmc.nl
Bouts
Antonia H
AH
Cornelissen
Elisabeth A M
EA
Lilien
Marc R
MR
Van Hoeck
Koen J
KJ
Hop
Wim C J
WC
Nauta
Jeroen
J
D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D000077552:Basiliximab; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D018849:Controlled Clinical Trials as Topic; D003404:Creatinine / Q000097:blood; D016572:Cyclosporine / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005919:Glomerular Filtration Rate / Q000502:physiology; D006084:Graft Rejection / Q000517:prevention & control; D006085:Graft Survival / Q000502:physiology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016030:Kidney Transplantation / Q000276:immunology* / Q000502:physiology*; D015999:Multivariate Analysis; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D011993:Recombinant Fusion Proteins / Q000627:therapeutic use; D020127:Recovery of Function / Q000502:physiology*; D012189:Retrospective Studies; D013997:Time Factors
D000305:Adrenal Cortex Hormones; D000911:Antibodies, Monoclonal; D007166:Immunosuppressive Agents; D011993:Recombinant Fusion Proteins; D016572:Cyclosporine; D000077552:Basiliximab; D003404:Creatinine; D009173:Mycophenolic Acid