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Patient selection critical for calcineurin inhibitor withdrawal in pediatric kidney transplantation
Author(s) -
Weintraub Lauren,
Li Li,
Kambham Neeraja,
Alexander Steven,
Concepcion Waldo,
Miller Kim,
Wong Cynthia,
Salvatierra Oscar,
Sarwal Minnie
Publication year - 2008
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.1399-3046.2007.00847.x
Subject(s) - medicine , sirolimus , trough level , calcineurin , urology , proteinuria , nephrotoxicity , renal function , immunosuppression , kidney transplantation , transplantation , creatinine , population , retrospective cohort study , surgery , tacrolimus , kidney , environmental health
CNI withdrawal may be employed as a “rescue” strategy for patients with established renal allograft injury and/or declining allograft function, with the aim at eliminating CNI‐associated nephrotoxic effects. This analysis reviews outcomes in a pediatric population and identifies risk factors for adverse events post‐CNI withdrawal. We performed a retrospective analysis of 17 pediatric renal transplants who underwent CNI withdrawal, with conversion to sirolimus and MMF. Mean CrCl decreased from 64.3 ± 22 to 59.38 ± 28.6 mL/min/1.73 m 2 (p = 0.04) at six months and 57.46 ± 31.1 mL/min/1.73 m 2 (p = 0.02) at 12 months post‐withdrawal. Forty‐one percent of patients experienced AR. Increased risk for AR was associated with prior AR history, lower sirolimus trough levels, and lower CNIT biopsy scores. Graft loss (24%) was associated with worse CrCl, proteinuria, and histologic chronicity. Proteinuria (spot protein/creatinine ratio) increased from 0.75 ± 1.0 to 1.71 ± 2.0 (p = 0.03), unrelated to de novo sirolimus use. Four patients returned to CNI‐based immunosuppression due to AR (n = 3) and gastrointestinal side effects (n = 1). Careful selection of pediatric candidates for CNI withdrawal is recommended. Worsening graft function and graft loss may be minimized by selecting patients with high CNIT scores and low biopsy chronicity and excluding patients with prior AR history.