title: Acute humoral rejection in pediatric renal transplant recipients receiving steroid minimization immunosuppression.
abstract: SM protocols have increasingly gained acceptance owing to their favorable side effect profile with comparable cellular rejection rates. After encountering SM patients with AHR, we performed a case-control study to identify predictors associated with AHR in this cohort. Patients with (n = 4) and without (n = 19) biopsy proven AHR on a SM regimen were compared using the Student's t-tests. The median age at transplant was 13.8 yr. Compared to controls, the AHR cohort was older (15.9 vs. 12.1 yr, p = 0.01). Children with AHR had a lower mean tacrolimus trough level and were more likely to have a sub-therapeutic trough at six months (3.5 vs. 5.5 ng/mL, p = 0.05); mean MMF doses were lower at all times points except three months in the AHR group (not statistically significant). This occurred in spite of higher MPA trough levels at all study points in the AHR group (significant at 3 [p = 0.019] and 6 [p = 0.03] months). Children receiving a SM regimen have a lower safety net and may benefit from more intensive monitoring of tacrolimus exposure. MMF dose modifications based on MPA trough determinations should be resisted in the setting of SM.
authors.affiliation: Department of Pediatrics, University of California Davis Medical Center, Sacramento, CA 95817, USA. lavjay.butani@ucdmc.ucdavis.edu
authors.forename: Lavjay
authors.initials: L
authors.lastname: Butani
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Gallay
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D001706:Biopsy; D016022:Case-Control Studies; D002648:Child; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D056724:Immunity, Humoral / Q000502:physiology*; D007165:Immunosuppression Therapy / Q000379:methods*; D007166:Immunosuppressive Agents / Q000494:pharmacology*; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000276:immunology / Q000379:methods; D008297:Male; D015233:Models, Statistical; D012189:Retrospective Studies; D013256:Steroids / Q000494:pharmacology*; D016559:Tacrolimus / Q000494:pharmacology; D014019:Tissue Donors; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D013256:Steroids; D016559:Tacrolimus