Infection rates in tacrolimus versus cyclosporine‐treated pediatric kidney transplant recipients on a rapid discontinuation of prednisone protocol: 1‐year analysis

Abstract

Introduction Acute rejection (AR) is lower in pediatric kidney transplant (pKTx) recipients on tacrolimus (Tac) versus cyclosporine (CsA). Data comparing infection outcomes for children treated with these agents are limited. Methods We retrospectively studied infection outcomes in 96 pKTx recipients on a rapid discontinuation of prednisone protocol (RDP). Patient survival (PS), death-censored graft survival (DCGS), AR and infection free survival were assessed using Kaplan-Meier/log-rank tests and proportional hazards models. Results There were no differences in 1-year PS, DCGS, or AR between Tac and CsA recipients. After adjusting for AR, the hazard of CMV viremia was 4.0 times higher (95%CI: 1.04, 15.5; p=0.044) and that of BK viremia was 3.8 times higher (95%CI: 1.5, 10.2; p=0.007) in Tac recipients. The incidence of EBV viremia was similar between the groups (p=0.56). Posttransplant lymphoproliferative disease was only observed in Tac recipients (3%). There was no difference in the incidence of pneumonia, urinary tract or clostridium difficile infections between Tac and CsA recipients. Conclusion Among KTx recipients on RDP, the hazards of CMV and BK viremia within 1-year post-KTx were significantly higher in Tac recipients compared to CsA. Regular assessment for infections and lower Tac trough levels may be warranted in Tac recipients.

Post‐transplant complications, patient, and graft survival in pediatric and adolescent kidney transplant recipients at a tropical tertiary care center across two immunosuppression eras

“…Urological NKD and DJ stenting, though associated with UTIs in this and other cohorts, 17 were no different between eras; therefore, it is likely that mycophenolate use may be responsible for the increase in UTI incidence. The incidence of CMV disease, BKVN, and other opportunistic infections has been reported to be higher in pediatric kidney transplant recipients receiving a tacrolimus and mycophenolate‐based regime 18,19 In addition, CMV, BKVN, and other viral infections had a lower person‐time incidence in the CNI withdrawal cohort, in keeping with published literature 13 . It is interesting that despite the more widespread use of valganciclovir prophylaxis in the last transplant era, CMV disease incidence increased.…”

Opportunistic Infections and Efficacy Following Conversion to Belatacept-Based Therapy after Kidney Transplantation: A French Multicenter Cohort

“…Most studies on this subject have assessed the risks of infections based on a CNI-based regimen. The global risk related to tacrolimus associated with a severe infection is similar to that for cyclosporine [23], although some studies report a higher risk of viral infection with tacrolimus (i.e., CMV infections and BK-virus nephropathy) [26,27]. However, very few studies have focused on the risks associated with infection and belatacept therapy.…”

Long-Term Outcomes of Kidney Transplantation in Children

“…While modern immunosuppression regimens have reduced the rate of acute rejection, infectious complications have become more frequent. [10][11][12] In particular, pediatric transplant recipients are at risk for developing virus-related complications due to immunological naiveté at the time of transplantation and primary infection under immunosuppressive therapy.…”