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De novo Therapy with Everolimus, Low‐Dose Ciclosporine A, Basiliximab and Steroid Elimination in Pediatric Kidney Transplantation
Author(s) -
Pape L.,
Offner G.,
Kreuzer M.,
Froede K.,
Drube J.,
Kanzelmeyer N.,
Ehrich J. H. H.,
Ahlenstiel T.
Publication year - 2010
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/j.1600-6143.2010.03266.x
Subject(s) - medicine , basiliximab , everolimus , prednisolone , immunosuppression , urology , renal function , kidney transplantation , transplantation , dosing , gastroenterology
The number of acute rejections and infections after pediatric kidney transplantation (KTX) could not be reduced in the last years. To reduce these events, we investigated a new immunosuppressive protocol in a prospective trial. After KTX, 20 children (median age 12 years, range 1–17) were initially treated with Basiliximab, ciclosporine A (CsA) (trough‐level = C0 200–250 ng/mL) and prednisolone. After 2 weeks, CsA dose was reduced to 50% (C0 75–100 ng/mL, after 6 months: 50–75 ng/mL) and everolimus (1.6 mg/m 2 /day) was started (C0 3–6 ng/mL). Six months after KTX prednisolone was set to alternate dose and stopped 3 months later. All 20 protocol biopsies 6 months after KTX showed no acute rejection or borderline findings. Indication biopsies resulted in no acute rejections and two borderline findings. Mean glomerular filtration rate (GFR) 1 year after KTX was 71 ± 25 mL/min/1.73 m 2 . Without cytomegalovirus (CMV)‐prophylaxis, only two primary CMV infections were seen despite a donor/recipient‐CMV‐constellation pos./neg. in 10/20 children. In pediatric KTX, de novo immunosuppression with low‐dose CsA, everolimus and steroid withdrawal after 9 months led to promising results according to numbers of acute rejections and infections. Further follow up is needed. Future larger trials will have to confirm our findings.