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Improved long‐term graft function in pediatric transplant renal recipients with chronic allograft nephropathy
Author(s) -
Kerecuk Larissa,
Horsfield Catherine,
Taylor Judy
Publication year - 2009
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.1399-3046.2008.00935.x
Subject(s) - medicine , renal function , urology , chronic allograft nephropathy , renal transplant , transplantation , surgery , adverse effect , nephropathy , retrospective cohort study , diabetes mellitus , endocrinology
CAN is the leading cause of graft loss in pediatric renal transplant recipients. A retrospective single centre analysis of pediatric transplant patients with CAN treated with MMF in conjunction with CNI minimisation/withdrawal is reported. 35 children were successfully started on MMF. The mean age at transplant was 7.9 ± 0.1 years. MMF was introduced 3.5 ± 0.1 years after transplantation and patients were followed up for a mean of 32.2 ± 0.5 months. CAN was confirmed on biopsy in 31 patients. CNI was stopped in 23 patients at a mean time of 16.5 ± 0.6 months after MMF introduction and minimised in the remaining patients. Prior to MMF introduction, GFR was deteriorating by 21.6 ± 0.07 ml/min/1.73 m 2 /yr. After MMF, there was an overall improvement in GFR of 4.0 ± 0.03 ml/min/1.73 m 2 /yr. This was most marked in the first six months when the GFR improved by 20.8 ± 0.06 ml/min/1.73 m 2 /day. Mean acute rejection episode rate prior to MMF was significantly reduced after MMF introduction. MMF was discontinued in a total of 4 patients due to adverse effects. CNI minimisation/withdrawal with MMF introduction is safe and leads to significant initial improvement with subsequent stabilisation of GFR and improved long term graft survival in pediatric renal transplant recipients with CAN.