Pediatric Kidney Transplantation Followed by De Novo Therapy With Everolimus, Low-Dose Cyclosporine A, and Steroid Elimination: 3-Year Data

Abstract

A treatment regimen consisting of de novo immunosuppression with basiliximab, CsA, and prednisolone, followed by treatment with everolimus and low-dose CsA combined with steroid withdrawal may be a promising therapy after pediatric KTX.

Basiliximab: efficacy and safety evaluation in kidney transplantation

“…A large RCT in kidney transplant recipients treated with tacrolimus showed that the incidence of biopsy-proven rejection and graft survival were similar in patients assigned to tacrolimus/basiliximab, in those assigned to tacrolimus/mycophenolate, and in those given tacrolimus, mycophenolate, and steroids, but there was a trend for a more favorable cardiovascular risk profile in patients with tacrolimus/basiliximab [41]. Steroid-free immunosuppression and low-dose cyclosporine regimen have also been successfully used in pediatric kidney transplantation [42].…”

New immunosuppressive agents in pediatric transplantation

“…Pape and colleagues found that the mean GFR at 1 and 3 years was 71 and 61 mL/min/1.73 m 2 , respectively. There were no cases of post-transplant lymphoproliferative disorder, acute rejection, or polyoma nephropathy, and 85% of the patients remained on the original immunosuppressive regimen (30). …”

Nierentransplantation im Kindesalter

“…Neuere Therapieprotokolle mit modernen Immunsuppressiva erlauben bei Patienten mit niedrigem oder mittlerem immunologischem Risiko ein Ausschleichen der Steroide 6 bis 12 Monate nach der Transplantation [6,15]. Wenn auf Steroide nicht verzichtet werden kann oder die Transplantatfunktion bereits deutlich [eGFR ("estimated glomerular filtration rate") < 40 ml/ min/1,73 m 2 ] eingeschränkt ist, kann eine Therapie mit rekombinantem humanem Wachstumshormon erwogen werden [18].…”