Induction and maintenance immunosuppression in pediatric kidney transplantation-Advances and controversies

被引：18
作者：
Balani, Shanthi S. [1 ]
Jensen, Chelsey J. [2 ]
Kouri, Anne M. [1 ]
Kizilbash, Sarah J. [1 ]
机构：
[1] Univ Minnesota, Pediat Nephrol, Minneapolis, MN USA
[2] Univ Minnesota, Solid Organ Transplant, Minneapolis, MN USA
来源：
PEDIATRIC TRANSPLANTATION | 2021年 / 25卷 / 07期
关键词：
immunosuppressive treatment; pediatric kidney transplantation; POSTTRANSPLANT LYMPHOPROLIFERATIVE DISORDER; MYCOPHENOLATE-MOFETIL SUSPENSION; ACUTE CELLULAR REJECTION; RANDOMIZED DOUBLE-BLIND; RENAL-TRANSPLANTATION; CALCINEURIN INHIBITOR; STEROID WITHDRAWAL; THYMOGLOBULIN INDUCTION; ANTIBODY INDUCTION; PHASE-III;
D O I：
10.1111/petr.14077
中图分类号：
R72 [儿科学];
学科分类号：
100202 ;
摘要：
Advances in immunosuppression have improved graft survival in pediatric kidney transplant recipients; however, treatment-related toxicities need to be balanced against the possibility of graft rejection. Several immunosuppressive agents are available for use in transplant recipients; however, the optimal combinations of agents remain unclear, resulting in variations in institutional protocols. Lymphocyte-depleting antibodies, specifically ATG, are the most common induction agent used for pediatric kidney transplantation in the US. Basiliximab may be used for induction in immunologically low-risk children; however, pediatric data are scarce. CNIs and antiproliferative agents (mostly Tac and mycophenolate in recent years) constitute the backbone of maintenance immunosuppression. Steroid-avoidance maintenance regimens remain controversial. Belatacept and mTOR inhibitors are used in children under specific circumstances such as non-adherence or CNI toxicity. This article reviews the indications, mechanism of action, efficacy, dosing, and side effect profiles of various immunosuppressive agents available for pediatric kidney transplantation.
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页数：15
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