Open AccessSubclinical Rejection and Immunosuppression in Pediatric Kidney Transplant Recipients : Single Centre Study
Author(s) -
Fatina I. Fadel,
Abeer M. Nour ElDin Abd ElBaky,
Mohamed A. Abdel Mawla,
Wesam Ismail Moustafa,
Gamal Saadi,
Doaa M. Salah
Publication year - 2021
Publication title -
biomedical and pharmacology journal/biomedical and pharmacology journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.191
H-Index - 18
eISSN - 2456-2610
pISSN - 0974-6242
DOI - 10.13005/bpj/2218
Subject(s) - medicine , subclinical infection , immunosuppression , tacrolimus , transplantation , biopsy , kidney transplantation , urology , surgery , pathological , gastroenterology
Background: By the time of histological confirmation of rejection is achieved, renal scarring may for treatment as a realistic option . This study aims to study the subclinical pathological graft data and to evaluate the histopathological impact of different immunosuppression protocols in pediatric renal transplant recipients. Methods: This is a case series that included twenty living donor renal transplant recipients. All included cases received the classic triple immunotherapy for at least one month post-transplantation [Steroids, calconurine inhibitors (CNI), and mycofenlolic mofetile (MMF)]. Based on their immunological risk stratification; included cases were divided into 2 groups: group (A) continued on CNI based triple therapy protocol; group (B) shifted to evirolimus /low dose CNI protocol. Surveillance biopsies were done for all cases at one and four month post-transplantation. Results: One and four month biopsies revealed subclinical rejection (including borderline changes) in 4 (20%) cases and 6 (30%) cases respectively. The number of patients received tacrolimus/MMF therapy significantly increased (p=0.02) while that of patients on everloimus/low dose CNI significantly decreased (p=0.014) due to drug modifications based on four month surveillance biopsy data. Conclusion: Subclinical rejection is not uncommon in pediatric renal graft recipients which makes surveillance biopsy might be of help. Early usage of evirolimus/low CNI protocol is associated with higher rejection rate than triple therapy.