title: Infection rates in tacrolimus versus cyclosporine-treated pediatric kidney transplant recipients on a rapid discontinuation of prednisone protocol: 1-year analysis.
abstract: AR is lower in pKTx recipients on Tac vs CsA. Data comparing infection outcomes for children treated with these agents are limited. We retrospectively studied infection outcomes in 96 pKTx recipients on a RDP. PS, DCGS, AR, and infection-free survival were assessed using Kaplan-Meier/log-rank tests and proportional hazards models. There were no differences in 1-year PS, DCGS, or AR between Tac and CsA recipients. After adjusting for AR, the hazard of CMV viremia was 4.0 times higher (95%CI: 1.04, 15.5; P = .044) and that of BK viremia was 3.8 times higher (95%CI: 1.5, 10.2; P = .007) in Tac recipients. The incidence of EBV viremia was similar between the groups (P = .56). PostTx lymphoproliferative disease was only observed in Tac recipients (3%). There was no difference in the incidence of pneumonia, urinary tract, or Clostridium difficile infections between Tac and CsA recipients. Among KTx recipients on RDP, the hazards of CMV and BK viremia within 1 year post-KTx were significantly higher in Tac recipients compared to CsA. Regular assessment for infections and lower Tac trough levels may be warranted in Tac recipients.
authors.affiliation: Department of Pediatric Nephrology, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Sarah J
authors.identifier: http://orcid.org/0000-0001-5824-7856
authors.initials: SJ
authors.lastname: Kizilbash
authors.affiliation: Department of Pediatric Nephrology, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Michelle N
authors.initials: MN
authors.lastname: Rheault
authors.affiliation: Biostatistics and Bioinformatics Core, Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Ananta
authors.initials: A
authors.lastname: Bangdiwala
authors.affiliation: Department of Transplant Surgery, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Arthur
authors.initials: A
authors.lastname: Matas
authors.affiliation: Department of Transplant Surgery, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Srinath
authors.initials: S
authors.lastname: Chinnakotla
authors.affiliation: Department of Pediatric Nephrology, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Blanche M
authors.initials: BM
authors.lastname: Chavers
mesh_terms: D000293:Adolescent; D001424:Bacterial Infections / Q000175:diagnosis / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control*; D002648:Child; D002675:Child, Preschool; D016572:Cyclosporine / Q000009:adverse effects* / Q000627:therapeutic use; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D015994:Incidence; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control; D011241:Prednisone / Q000009:adverse effects* / Q000627:therapeutic use; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016559:Tacrolimus / Q000009:adverse effects* / Q000627:therapeutic use; D016896:Treatment Outcome; D014777:Virus Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control*
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine; D011241:Prednisone; D016559:Tacrolimus
keywords: cyclosporine; cytomegalovirus; kidney transplant; pediatrics; steroid avoidance; tacrolimus