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

被引：21

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.

引用

页数：15

共 143 条

[1] Short course induction immunosuppression with thymoglobulin for renal transplant recipients [J].

Agha, IA ;

Rueda, J ;

Alvarez, A ;

Singer, GG ;

Miller, BW ;

Flavin, K ;

Lowell, JA ;

Shenoy, S ;

Howard, TK ;

Ramachandran, V ;

Irish, W ;

Schnitzle, MA ;

Brennan, DC .

TRANSPLANTATION, 2002, 73 (03) :473-475

[2] Azathioprine Versus Mycophenolate Mofetil in Combination with Tacrolimus and Steroids Maintenance in Pediatric Kidney Transplantation [J].

Al-Mowaina, Sahar .

TRANSPLANTATION, 2018, 102 :S839-S839

[3] Posttransplant diabetes mellitus in pediatric renal transplant recipients: A report of the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS) [J].

Al-Uzri, A ;

Stablein, DM ;

Cohn, RA .

TRANSPLANTATION, 2001, 72 (06) :1020-1024

[4]

Alemtuzumab, 2021, MICR SOL

[5] Rapamycin retards growth and causes marked alterations in the growth plate of young rats [J].

Alvarez-Garcia, Oscar ;

Carbajo-Perez, Eduardo ;

Garcia, Enrique ;

Gil, Helena ;

Molinos, Ines ;

Rodriguez, Julian ;

Ordonez, Flor A. ;

Santos, Fernando .

PEDIATRIC NEPHROLOGY, 2007, 22 (07) :954-961

[6]

[Anonymous], 2018, FDA PACKAGE INSERT Z

[7]

[Anonymous], 2017, FDA PACKAGE INSERT R

[8]

[Anonymous], 2020, CAMPATH AL INJ PACK

[9] Summary of the US FDA Approval of Belatacept [J].

Archdeacon, P. ;

Dixon, C. ;

Belen, O. ;

Albrecht, R. ;

Meyer, J. .

AMERICAN JOURNAL OF TRANSPLANTATION, 2012, 12 (03) :554-562

[10] Reassessing Rabbit Antithymocyte Globulin Induction in Kidney Transplantation (RETHINK): An Analysis of the North American Pediatric Renal Trials and Collaborative Studies (NAPRTCS) Registry [J].

Ashoor, Isa F. ;

Martz, Karen ;

Galbiati, Shirley ;

Beyl, Robbie A. ;

Dharnidharka, Vikas R. .

TRANSPLANTATION DIRECT, 2020, 6 (09) :E598

← 1 2 3 4 5 6 7 8 9 10 →