title: Correlations with six-month protocol biopsy findings in pediatric transplant recipients on low- and regular-dose CNI regimens.
abstract: Protocol biopsies (PB) are seldom performed after pediatric kidney transplantation (KTx), and factors influencing PB results have not previously been investigated. We performed PB in 79 children six months after KTx and evaluated the results using Banff 2007 criteria. Complications such as bleeding or infections were not detected. The influence of different variables on PB results was evaluated by covariance analysis. Children treated with a low-dose calcineurin inhibitor (CNI) together with an mTOR inhibitor exhibited decreased subclinical rejection (0% vs. 19%, p = 0.001) and decreased interstitial fibrosis and tubular atrophy (IF/TA) (15% vs. 42%, p = 0.013) compared with patients treated with a conventional regimen consisting of normal-dose CNI and mycophenolate mofetil. Children with IF/TA had a lower GFR four wk after Tx (83 ± 22 vs. 62 ± 20 mL/min/1.73 m(2) , p = 0.001). Cold ischemia time, living-related donors, pre-emptive KTx, and donor age did not influence PB results. Treatment with low-dose CNI and mTOR inhibitor and high GFR directly after Tx are the main factors associated with less inflammation and fibrosis in PB and might therefore lead to better long-term graft function.
authors: Department of Pediatric Nephrology, Hannover Medical School, Hannover, Germany. Kanzelmeyer.Nele@mh-hannover.de
authors: Nele K
authors: NK
authors: Kanzelmeyer
authors: Thurid
authors: T
authors: Ahlenstiel
authors: Martin
authors: M
authors: Kreuzer
authors: Jan U
authors: JU
authors: Becker
authors: Lars
authors: L
authors: Pape
mesh_terms: D000293:Adolescent; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D016572:Cyclosporine / Q000008:administration & dosage* / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D000068338:Everolimus; D005260:Female; D005355:Fibrosis / Q000209:etiology / Q000473:pathology / Q000517:prevention & control; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000473:pathology* / Q000517:prevention & control; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D007668:Kidney / Q000473:pathology* / Q000502:physiology; D016030:Kidney Transplantation; D008297:Male; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D011182:Postoperative Care; D011183:Postoperative Complications / Q000473:pathology / Q000517:prevention & control; D011239:Prednisolone / Q000627:therapeutic use; D020123:Sirolimus / Q000031:analogs & derivatives / Q000627:therapeutic use; D016559:Tacrolimus / Q000008:administration & dosage* / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine; D000068338:Everolimus; D011239:Prednisolone; D009173:Mycophenolic Acid; D020123:Sirolimus; D016559:Tacrolimus