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Early protocol biopsies in pediatric renal transplantation: Interest for the adaptation of immunosuppression
Author(s) -
Bruel Alexandra,
AllainLaunay Emma,
Humbert Julie,
Ryckewaert Amélie,
Champion Gérard,
Moreau Anne,
Renaudin Karine,
Karam Georges,
RousseyKesler Gwenaelle
Publication year - 2014
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/petr.12197
Subject(s) - medicine , immunosuppression , subclinical infection , tacrolimus , transplantation , kidney transplantation , urology , gastroenterology , surgery
GPB are often performed in PRT to detect subclinical acute rejection or IF / TA . Reducing immunosuppression side effects without increasing rejection is a major concern in PRT. We report the results of GPB in children transplanted with a steroid‐sparing protocol adapted to immunological risk. Children under 18 yr who received a renal transplantation between April 1, 2009 and May 31, 2012 were included. Immunosuppression consisted of an antibody induction therapy, tacrolimus, and MMF for all recipients. CSs were administered to children under five yr old, or receiving a second allograft. Twenty‐eight children were included, 50% were CSs free. GPB were performed between three and six months. IF / TA was documented in seven biopsies; four of these seven children were CS free. One child, with CSs, presented a borderline rejection, and another child, steroid free, with significant inflammatory interstitial infiltrate, considered as a subclinical rejection, was treated with CSs pulses. The median eGFR was stable (74, 67.5, and 82 mL/min/1.73 m² at, respectively, seven days, three months, and one yr). Patient and graft survival were 100%. These results have to be confirmed in a larger cohort, with long‐term follow‐up.