Tacrolimus-based immunosuppression with steroid withdrawal in pediatric kidney transplantation - 4-year experience at a moderate-volume center

Tacrolimus-based immunosuppression with steroid withdrawal in pediatric kidney transplantation was pioneered at the University of Pittsburgh but is not broadly practiced at other centers. We present our 4-year experience with a modified Pittsburgh protocol at our own moderate-volume center. Seventeen pediatric kidney transplant recipients were treated with a tacrolimus-based immunosuppressive regimen involving steroid withdrawal over 6-12 post-transplant months in most cases and followed for up to 49 months. Patient and graft survival as well as graft function were excellent, and beneficial effects on several cardiovascular parameters were noted. Complications included fungal infections, glucose intolerance and post-transplant lymphoproliferative disease and were generally managed successfully. While awaiting longer-term follow-up data, we conclude that tacrolimus-based immunosuppression with steroid withdrawal in pediatric kidney transplantation is potentially beneficial and feasible even at centers managing a rather small number of recipients.