title: Protocol biopsies in pediatric renal transplant recipients on cyclosporine versus tacrolimus-based immunosuppression.
abstract: BACKGROUND
  Protocol biopsies can detect subclinical rejection and early signs of calcineurin inhibitor-induced nephrotoxicity.
  
  
  METHODS
  In a prospective study, protocol biopsies 3 and 12 months after transplant in transplanted children from two centers were studied. One center used cyclosporine (CsA)-based immunosuppression and the other center used tacrolimus. Patients were on CsA (n = 26, group 1) or on tacrolimus (n = 10, group 2). Patients received basiliximab induction, mycophenolate mofetil, and prednisone.
  
  
  RESULTS
  In patients on CsA, 26 kidney biopsies were performed during the 6 months after transplantation. Eighteen protocol biopsies were performed at 3 months post transplant; 13 were normal and five showed rejection (two borderline and three Banff II rejections). Eight biopsies were motivated by an increase of serum creatinine; four were normal and four revealed signs of acute rejection (two borderline and two Banff II). Twelve protocol biopsies were performed after 12 months; all were normal. For patients on tacrolimus (n = 10), ten protocol transplant biopsies were performed at 3 months post-transplant; none showed signs of rejection. No biopsy was performed for an increase of serum creatinine. There were no differences in patient age, number of human leukocyteantigen (HLA) incompatibilities, or other patient characteristics.
  
  
  CONCLUSIONS
  Patients on tacrolimus had less acute rejection episodes detected on protocol biopsies 3 months after transplant. Protocol biopsies seem to play an important role in the detection of subclinical rejection in patients on CsA.
authors.affiliation: Service de Néphrologie et Dialyses Pédiatrique, Hôpital Armand Trousseau, Avenue du Docteur Netter, 75012 Paris, France.
authors.forename: Bilal
authors.initials: B
authors.lastname: Aoun
authors.forename: Stéphane
authors.initials: S
authors.lastname: Decramer
authors.forename: Renata
authors.initials: R
authors.lastname: Vitkevic
authors.forename: Hala
authors.initials: H
authors.lastname: Wannous
authors.forename: Flavio
authors.initials: F
authors.lastname: Bandin
authors.forename: Christine
authors.initials: C
authors.lastname: Azema
authors.forename: Patrice
authors.initials: P
authors.lastname: Callard
authors.forename: Isabelle
authors.initials: I
authors.lastname: Brocheriou
authors.forename: Tim
authors.initials: T
authors.lastname: Ulinski
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D003404:Creatinine / Q000097:blood; D016572:Cyclosporine / Q000009:adverse effects / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D006084:Graft Rejection / Q000097:blood / Q000276:immunology / Q000473:pathology / Q000517:prevention & control*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D007223:Infant; D007668:Kidney / Q000187:drug effects* / Q000276:immunology / Q000473:pathology; D016030:Kidney Transplantation / Q000009:adverse effects / Q000276:immunology*; D008297:Male; D010297:Paris; D011237:Predictive Value of Tests; D011446:Prospective Studies; D016559:Tacrolimus / Q000009:adverse effects / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D003404:Creatinine; D016559:Tacrolimus