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Five‐year experience using sirolimus‐based, calcineurin inhibitor‐free immunosuppression in pediatric renal transplantation
Author(s) -
Hymes Leonard C.,
Warshaw Barry L.
Publication year - 2011
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.1399-3046.2011.01477.x
Subject(s) - medicine , basiliximab , immunosuppression , transplantation , sirolimus , adverse effect , prednisone , mycophenolic acid , bk virus , calcineurin , surgery , gastroenterology , kidney transplantation
Hymes LC, Warshaw BL. Five‐year experience using sirolimus‐based, calcineurin inhibitor‐free immunosuppression in pediatric renal transplantation.
Pediatr Transplantation 2011: 15: 437–441. © 2011 John Wiley & Sons A/S. Abstract: From December 2003 to December 2008, we employed a protocol for withdrawing TAC and converting to SRL in a cohort of low‐risk renal pediatric transplant recipients. We report our experience in these children with respect to graft survival, AR episodes, renal function, and adverse events. All patients received basiliximab induction and TAC, MMF, and prednisone. Criteria for conversion to SRL included first transplants without histologic evidence for AR on three‐month surveillance biopsies. Patient exclusion criteria included AR prior to or before surveillance biopsies, polyoma (BK) virus nephropathy, a history of nephrotic syndrome, or multiple organ transplants. Fifty‐one of 137 patients who received transplants from December 2003 to December 2008 met criteria for withdrawal of TAC and were converted to SRL. SRL was discontinued in 11 children because of adverse events within 12 months after conversion. Among the remaining 40 patients, actuarial graft survival was 91% at five yr. AR occurred in 13% of patients within one yr after conversion. Complications from SRL included aphthous ulcers (30%); viremia with BK virus (20%), EBV (13%), and CMV (3%); proteinuria (7%); elevated cholesterol (7%); diabetes mellitus (2%); thrombocytopenia (2%); erectile dysfunction (2%); and lymph edema (2%). SRL was discontinued in 20%, predominantly for aphthous ulcers. Our experience with SRL‐based immunosuppression demonstrates that a CNI‐free regimen can be successful in lower‐risk patients meeting our selection criteria. Aphthous ulcers and BK virus viremia were the most prevalent adverse events.