Organ transplantation is a life-saving therapy that has revolutionized the field of medicine over the last 100 years. The first successful non-identical kidney transplant was performed in a 24-year-old man in 1959 using total body irradiation for immunosuppression. This was the first instance of the permeation of the immunological barrier to organ transplantation. In early 1960s, the immunosuppressive properties of (AZA) and prednisone were recognized, and in 1966, the immunosuppressive effects of antilymphocyte serum were discovered. 1 These early discoveries transformed the field of organ transplantation from a mere vision to a promising reality. As illustrated by a retrospective study of 56 pediatric kidney transplant recipients, transplanted between 1963 and 1971, 1-year graft survival in living-donor recipients improved from 50% before antilymphocyte serum to nearly 90% after the institution of antilymphocyte serum in conjunction with AZA and prednisone. 2 The next major advance in immunosuppression occurred in 1976 when J.F Borel discovered (CSA). 1 The discovery of CSA (FDA approved in 1983) was particularly important for children, as it allowed

Human cytomegalovirus (CMV) remains one of the most common opportunistic infections following solid organ transplantation in children. CMV causes morbidity and mortality through direct tissue-invasive disease and indirect immunomodulatory effects. In recent years, several new agents have emerged for the prevention and treatment of CMV disease in solid organ transplant recipients. However, pediatric data remain scarce, and many of the treatments are extrapolated from the adult literature. Controversies exist about the type and duration of prophylactic therapies and the optimal dosing of antiviral agents. This review provides an up-to-date overview of treatment modalities used to prevent and treat CMV disease in solid organ transplant (SOT) recipients.

There is paucity in the data examining the differences in mycophenolate mofetil (MMF) dosing and outcomes among pediatric kidney transplant recipients (PKTX) between races. The aims of this study were as follows (i) to assess whether higher doses of MMF are being utilized in African American (AA) PKTX (ii) to determine whether there is a correlation between MMF dose and outcomes between races, and (iii) to assess the adverse effects of MMF between races. This study analyzed 109 PKTX who received MMF between 7/99 and 5/08. Demographics were similar between groups. Fewer AAs received kidneys from living donors (18% vs. 44%), spent more time on dialysis (1.0 vs. 0.5 yr), and had more human leukocyte antigen mismatches (4 vs. 3). MMF doses among AA patients were higher throughout the study, with statistical differences at week 4, month 3, and month 18. AA patients had significantly higher acute rejection rates and trended toward poorer graft survival; infections, adverse events from MMF and post-transplant lymphoproliferative disease tended to be lower in the AA patients. AA PKTX received higher MMF doses within the first three yr post-transplant compared to their non-AA counterparts, yet demonstrate significantly more acute rejection episodes. Importantly, MMF caused fewer adverse events in AA patients, despite these patients receiving higher doses.

Background Corticosteroids have been an integral part of maintenance immunosuppression for pediatric kidney transplantation. However, prolonged steroid therapy is associated with significant toxicities resulting in several SW/avoidance strategies in recent years. Method/Objective This comprehensive review aims to discuss steroid‐related toxicities and the safety, efficacy, and benefit of steroid avoidance/withdrawal immunosuppression in pediatric kidney transplant recipients. Results Initial studies of SW/avoidance conducted in the setting of CSA and AZA showed an increased incidence of AR but no increase in graft loss or mortality with SW/avoidance maintenance immunosuppression. Studies performed under modern immunosuppression (induction therapy, Tac, and MMF) show no significant increase in AR or graft loss with SW/avoidance immunosuppression. Furthermore, SW/avoidance immunosuppression is associated with significant improvement in growth, BMI, BP control, and lipid profile in pediatric kidney transplant recipients. Despite these data, SW/avoidance remains controversial, and only 40% of pediatric kidney transplant recipients in the United States are currently on SW/avoidance maintenance immunosuppression. Conclusion SW/avoidance maintenance immunosuppression is safe and associated with fewer side effects compared with steroid‐inclusive maintenance immunosuppression in pediatric kidney transplant recipients.

Kidney transplantation is the treatment of choice for children with end-stage kidney disease. Due to recent advances in immunosuppression (IS), posttransplant infections have emerged as an important cause of morbidity and mortality in pediatric kidney transplant recipients. BK virus is a common infection seen after pediatric kidney transplantation. BK virus is a non-encapsulated, double-stranded DNA virus belonging to the Polyomaviridae family of viruses. 1 It is widespread in the general population with a seroprevalence rate of