One-year results of basiliximab induction and tacrolimus associated with sequential steroid and MMF treatment in pediatric kidney transplant recipient

Giovanni Montini, Luisa Murer, Luciana Ghio, Beatrice Pietrobon, Fabrizio Ginevri, Mariano Ferraresso, Massimo Cardillo, Mario Scalamogna, Francesco Perfumo, Alberto Edefonti, Giovanni Franco Zanon, Graziella Zacchello

Research output: Contribution to journalArticle

Abstract

We report the 1-year results with a triple immunosuppressive regimen in pediatric recipients of a first kidney transplant, in order to evaluate its safety and efficacy in the prevention of acute rejection and in the reduction of steroid side effects. The immunosuppression is as follows: (i) basiliximab (20 mg if body weight > 30 kg; 10 mg if <30 kg) is given pretransplant and at day 4; (ii) tacrolimus (Tac) is administered in order to obtain blood trough levels of 10-20 and 5-10 ng/ml during and after the first 2 months post-transplant, respectively; (iii) steroids are tapered during the first 6 months and then replaced by mycophenolate mofetil (depending on previous rejection episodes, infection status and the result of a routine biopsy) at a dosage of 4-600 mg/m2 body surface area. Fifty-three children (median age 13 years, range 2-20) have entered this protocol. One-year patient and kidney survival are 100% and 94% respectively. During the first year a total of nine rejections in seven patients (13% of the cohort study) occurred, all but one responsive to steroids. Renal function was satisfactory throughout the first year (mean CrCl was 63.8 ± 18 and 60.9 ± 15.5 ml/min/1.73 m at 6 and 12 months respectively). Subclinical signs of rejection were absent in more than 80% of biopsies (grade I Banff) at 6 months (n = 47); at the 12th month biopsy (n = 42) score I was stable in 20 patients (16 after stopping steroids) and had worsened in eight biopsies (six after stopping steroids). Major complications were insulin-dependent diabetes in three (5.6%) children with the need of insulin for a mean of 3 months; transient hyperglycemia (11 patients), treated with a dietary regimen, symptomatic viral infections (in 11 patients: two parvovirus B19, three cytomegalovirus and two Epstein-Barr virus systemic infections, three interstitial pneumonia, two BK nephritis). Tac doses more than 0.3-0.4 mg/kg/day are at significantly higher risk of viral infection. In conclusion, this immunosuppressive regimen is associated with a low percentage of clinical (13%) and subclinical rejections, but with a relatively high number of infections, prevented by a reduction in Tac doses (<0.3 mg/kg/day) during the first 2 months after transplantation. The assessment of steroid withdrawal needs a longer follow-up.

Original languageEnglish
Pages (from-to)36-42
Number of pages7
JournalTransplant International
Volume18
Issue number1
DOIs
Publication statusPublished - Jan 2005

Keywords

  • Acute rejection
  • Banff classification
  • Basiliximab
  • Children
  • Kidney transplantation
  • Mycophenolate mofetil
  • Renal transplantation
  • Routine biopsies
  • Steroid withdrawal
  • Tacrolimus

ASJC Scopus subject areas

  • Transplantation

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