Outcomes of two-drug maintenance immunosuppression for pediatric renal transplantation: 10-yr follow-up in a single center

Pediatr Transplant. 2016 Feb;20(1):49-58. doi: 10.1111/petr.12627. Epub 2015 Nov 2.

Abstract

Minimizing IS to reduce side effects without compromising long-term renal transplant survival is the goal of all IS protocols. We conducted a retrospective study of pediatric renal transplants performed August 1988 to July 2008 and treated with two-drug maintenance therapy by one of three protocols: prednisone/cyclosporine without induction (SB) or with daclizumab induction (SBI), or tacrolimus/mycophenolate with daclizumab induction (SF). Kaplan-Meier survival curves were used to determine graft and patient survival at one, three, five, and 10 yr. Associations between graft survival and patient/transplant characteristics were determined using log-rank test and CPH model adjusting for treatment group. About 208 patients were included in the analysis (96 SB, 97 SBI, 15 SF; 148 DD, 60 LD, 37 pre-emptive). Overall graft and patient survival at one, three, five, and 10 yr were similar to the previously published results of pediatric renal transplants in similar years treated predominantly with three-drug maintenance therapy (https://web.emmes.com/study/ped/annlrept/2010). Only biopsy-proven TG was significantly associated with worse graft survival (HR 11.5, 95% CI: 3.4, 38.7). Malignancy rate was low (2.4%) with little PTLD (0.5%). Few opportunistic or other infections occurred (<5% patients). Minimizing IS to a two-drug maintenance regimen had no adverse effect on long-term transplant outcome and had low malignancy and infection rates.

Keywords: acute rejection; graft survival; immunosuppression; outcome; pediatric renal transplant.

MeSH terms

  • Adolescent
  • Adult
  • Antibodies, Monoclonal, Humanized / administration & dosage
  • Antibodies, Monoclonal, Humanized / therapeutic use
  • Biopsy
  • Child
  • Cyclosporine / administration & dosage
  • Cyclosporine / therapeutic use
  • Daclizumab
  • Drug Therapy, Combination
  • Female
  • Follow-Up Studies
  • Graft Survival
  • Humans
  • Immunoglobulin G / administration & dosage
  • Immunoglobulin G / therapeutic use
  • Immunosuppression Therapy / methods*
  • Immunosuppressive Agents / administration & dosage*
  • Immunosuppressive Agents / therapeutic use
  • Kaplan-Meier Estimate
  • Kidney Transplantation*
  • Male
  • Multivariate Analysis
  • Mycophenolic Acid / administration & dosage
  • Mycophenolic Acid / therapeutic use
  • Prednisone / administration & dosage
  • Prednisone / therapeutic use
  • Proportional Hazards Models
  • Renal Insufficiency / surgery*
  • Retrospective Studies
  • Tacrolimus / administration & dosage
  • Tacrolimus / therapeutic use
  • Time Factors
  • Treatment Outcome
  • Young Adult

Substances

  • Antibodies, Monoclonal, Humanized
  • Immunoglobulin G
  • Immunosuppressive Agents
  • Cyclosporine
  • Daclizumab
  • Mycophenolic Acid
  • Prednisone
  • Tacrolimus