title: Pubertal Development in Pediatric Kidney Transplant Patients Receiving Mammalian Target of Rapamycin Inhibitors or Conventional Immunosuppression.
abstract: BACKGROUND
  Data regarding the onset of puberty in children receiving mammalian target of rapamycin (mTOR) inhibitors are limited.
  
  
  METHODS
  Kidney transplant patients aged <14 years were analyzed retrospectively to a maximum age of 18 years, with a minimal observation period of 1 year. Immunosuppression comprised (1) standard CNI-based regimen or (2) low-exposure mTOR inhibitor with reduced-exposure CNI, initiated either de novo or in the maintenance phase.
  
  
  RESULTS
  Of 108 children analyzed, 67 received an mTOR inhibitor (56 everolimus, 11 sirolimus) and 41 did not. The age at which girls reached Tanner stage P2 was similar with mTOR inhibitor therapy (median 11.6 years) or without (median 11.1 years) (P = 0.262), as was age at stage B2 (median 11.6 vs. 11.2 years; P = 0.753). In boys, both the age of attaining Tanner stage P2 (median 12.9 vs. 13.0 years; P = 0.796) and Tanner stage G2 (median 13.1 vs. 12.9 years; P = 0.344) were also similar with or without an mTOR inhibitor. Age at menarche in girls, and age at spermarche in boys, did not differ between the 2 groups.
  
  
  CONCLUSIONS
  In this retrospective analysis, sexual maturation ages and reproductive hormone levels were comparable in adolescent kidney transplant patients receiving low-exposure mTOR inhibitors and reduced CNI therapy or conventional CNI-based immunosuppression.
authors.affiliation: 1 Department of Pediatric Nephrology, Hannover Medical School, Hannover, Germany. 2 Integrated Treatment and Research Center for Transplantation, Hannover Medical School, Hannover, Germany. 3 Department of Medical Statistics, University Medical Center Göttingen, Gottingen, Germany. 4 Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Julia
authors.initials: J
authors.lastname: Förster
authors.forename: Thurid
authors.initials: T
authors.lastname: Ahlenstiel-Grunow
authors.forename: Antonia
authors.initials: A
authors.lastname: Zapf
authors.forename: Martin
authors.initials: M
authors.lastname: Mynarek
authors.forename: Lars
authors.initials: L
authors.lastname: Pape
mesh_terms: D000293:Adolescent; D000735:Androstenedione / Q000097:blood; D002648:Child; D002675:Child, Preschool; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007165:Immunosuppression Therapy; D007223:Infant; D016030:Kidney Transplantation; D008297:Male; D011627:Puberty / Q000502:physiology*; D012189:Retrospective Studies; D058570:TOR Serine-Threonine Kinases / Q000037:antagonists & inhibitors*; D013739:Testosterone / Q000097:blood
chemical_list: D013739:Testosterone; D000735:Androstenedione; D058570:TOR Serine-Threonine Kinases