title: Early protocol biopsies in pediatric renal transplantation: interest for the adaptation of immunosuppression.
abstract: GPB are often performed in PRT to detect subclinical acute rejection or IF/TA. Reducing immunosuppression side effects without increasing rejection is a major concern in PRT. We report the results of GPB in children transplanted with a steroid-sparing protocol adapted to immunological risk. Children under 18 yr who received a renal transplantation between April 1, 2009 and May 31, 2012 were included. Immunosuppression consisted of an antibody induction therapy, tacrolimus, and MMF for all recipients. CSs were administered to children under five yr old, or receiving a second allograft. Twenty-eight children were included, 50% were CSs free. GPB were performed between three and six months. IF/TA was documented in seven biopsies; four of these seven children were CS free. One child, with CSs, presented a borderline rejection, and another child, steroid free, with significant inflammatory interstitial infiltrate, considered as a subclinical rejection, was treated with CSs pulses. The median eGFR was stable (74, 67.5, and 82 mL/min/1.73 m² at, respectively, seven days, three months, and one yr). Patient and graft survival were 100%. These results have to be confirmed in a larger cohort, with long-term follow-up.
authors.affiliation: Department of Pediatrics, Nantes University Hospital, Nantes, France.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Bruel
authors.forename: Emma
authors.initials: E
authors.lastname: Allain-Launay
authors.forename: Julie
authors.initials: J
authors.lastname: Humbert
authors.forename: Amélie
authors.initials: A
authors.lastname: Ryckewaert
authors.forename: Gérard
authors.initials: G
authors.lastname: Champion
authors.forename: Anne
authors.initials: A
authors.lastname: Moreau
authors.forename: Karine
authors.initials: K
authors.lastname: Renaudin
authors.forename: Georges
authors.initials: G
authors.lastname: Karam
authors.forename: Gwenaelle
authors.initials: G
authors.lastname: Roussey-Kesler
mesh_terms: D000903:Antibiotics, Antineoplastic / Q000627:therapeutic use; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods*; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007249:Inflammation; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D009173:Mycophenolic Acid / Q000008:administration & dosage; D051437:Renal Insufficiency / Q000601:surgery*; D013256:Steroids / Q000627:therapeutic use; D016559:Tacrolimus / Q000008:administration & dosage
chemical_list: D000903:Antibiotics, Antineoplastic; D007166:Immunosuppressive Agents; D013256:Steroids; D009173:Mycophenolic Acid; D016559:Tacrolimus
keywords: immunological risk; pediatric renal transplantation; protocol biopsies; steroid minimization