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

被引：19

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

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