Tacrolimus-based immunosuppression with steroid withdrawal in pediatric kidney transplantation was pioneered at the University of Pittsburgh but is not broadly practiced at other centers. We present our 4-year experience with a modified Pittsburgh protocol at our own moderate-volume center. Seventeen pediatric kidney transplant recipients were treated with a tacrolimus-based immunosuppressive regimen involving steroid withdrawal over 6-12 post-transplant months in most cases and followed for up to 49 months. Patient and graft survival as well as graft function were excellent, and beneficial effects on several cardiovascular parameters were noted. Complications included fungal infections, glucose intolerance and post-transplant lymphoproliferative disease and were generally managed successfully. While awaiting longer-term follow-up data, we conclude that tacrolimus-based immunosuppression with steroid withdrawal in pediatric kidney transplantation is potentially beneficial and feasible even at centers managing a rather small number of recipients.

An open, prospective, randomised trial was conducted to compare the incidence of significant bacteriuria following 2 methods of intermittent urethral catheterisation in patients with acute spinal cord trauma. Twenty-two patients were catheterised with a Nelaton catheter and 50 ml of Trisdine were instilled into the bladder and left there immediately prior to withdrawal of the catheter. Fifteen patients were catheterised with a Nelaton catheter with a special introducer to improve asepsis (O'Neil catheter). The mean incidence of significant bacteriuria in males and females who received Trisdine bladder instillations was 0.58 and 0.48% per catheterisation respectively; in males and females catheterised with the O'Neil catheter it was 1.16 and 2.93% per catheterisation respectively. The instillation of Trisdine into the bladder after each passage of a catheter resulted in a significantly lower incidence of bacteriuria compared with that which resulted from the use of the O'Neil catheter. The former method is therefore to be preferred for aseptic intermittent urethral catheterisation in patients with acute spinal cord trauma.