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SRL‐based immunosuppression vs. CNI minimization in pediatric renal transplant recipients with chronic CNI nephrotoxicity
Author(s) -
Höcker Britta,
Feneberg Reinhard,
Köpf Sabine,
Weber Lutz T.,
Waldherr Rüdiger,
Wühl Elke,
Tönshoff Burkhard
Publication year - 2006
Publication title -
pediatric transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.457
H-Index - 69
eISSN - 1399-3046
pISSN - 1397-3142
DOI - 10.1111/j.1399-3046.2006.00526.x
Subject(s) - medicine , calcineurin , urology , nephrotoxicity , immunosuppression , renal function , regimen , kidney transplantation , adverse effect , tacrolimus , transplantation , kidney
Because calcineurin inhibitor (CNI)‐induced nephrotoxicity contributes significantly to late renal allograft loss, sirolimus (SRL)‐based, CNI‐free maintenance immunosuppression has been advocated, but data in the pediatric population are scarce. We therefore analyzed the efficacy and safety of an SRL‐based immunosuppressive regimen plus mycophenolate mofetil (MMF) and corticosteroids vs. CNI minimization (mean dose reduction by 39%) plus MMF and corticosteroids in 19 pediatric recipients with biopsy‐proven CNI‐induced nephrotoxicity in a single‐center case–control study. In the SRL group, we observed, one yr after study entry, an improvement of glomerular filtration rate (GFR) by 10.3 ± 3.0 mL/min/1.73 m 2 (p < 0.05 vs. baseline) in seven of 10 patients and a stabilization in the remaining three, while in the CNI minimization group GFR improved by 17.7 ± 7.1 mL/min/1.73 m 2 (p < 0.05) in six of nine recipients and stabilized in the remaining three. No patient in either group experienced an acute rejection episode. The main adverse event under SRL therapy was a transient hyperlipidemia in 70% of patients. In pediatric renal transplant recipients with declining graft function because of CNI‐induced nephrotoxicity, CNI withdrawal and switch to SRL‐based therapy or CNI minimization are associated with a comparable improvement of GFR after 12 months of observation.