Abstract
Pediatric patients, 2-20 y.o., who received renal transplants (TX) after Jan, 1984, were treated with CsA+PRED immunosuppression. Oral CsA was initiated at 14mg/kg/d and tapered individually by clinical course and trough serum CsA (SCsA), to 7-9mg/kg/d by 6 mon. High dose PRED, 2-3mg/kg/d, was begun the day of surgery, tapered to 1mg/kg/d by 1 mon and maintained at low dose, 0.2-0.4 mg/kg/d, after 2 mon. Nine grafts are all functioning after short term follow-up (F/U) (54 patient mon). The youngest recipients, ages 2-6 y.o. (n=5:4 LRD, 1 CAD), demonstrated rapid growth rates, 0.96-1.25cm/mon, during 4-9 mon F/U. Estimated GFR at last F/U was 75-109ml/min/1.73m2 (range Scr 0.5-0.8mg/dl). One patient experienced reversible acute rejection at 2mon, but still grew rapidly (1.25cm/mon). No young child had CsA nephrotoxicity. Trough SCsA was always <85ng/ml. Older children grew less-well. An 11 y.o. LRD recipient with Scr 1.8mg/dl and GFR 43ml/min/1.73m2 grew 0.5cm/mon during 8 mon F/U. Three older recipients (15-20 y.o. : 1 LRD, 2 CAD) had bone age >13 y.o. and demonstrated little growth (0-0.16cm/mon) in 3-8mon F/U; Scr was 1.4-2.2mg/dl and GFR 55-58ml/min/1.73m2. One had reversible acute rejection during wk one. Another had reversible CsA nephrotoxicity. Other CsA toxic side effects were hirsuitism (9/9), hand tremor (5/9) and asymptomatic high serum uric acid (6.7-13.5mg/dl) (9/9). Our experience suggests CsA+PRED in pediatric TX recipients 1) permits rapid growth, especially in young children, 2) is not limited, at least initially, by nephrotoxicity and 3) leads to early successful pediatric TX outcome.
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Brewer, E., Sieqler, R., Alexander, D. et al. 1578 RAPID GROWTH IN YOUNG CHILDREN AFTER RENAL TRANSPLAN TATION USING CYCLOSPORINE (CsA) AND PREDNISONE (PRED). Pediatr Res 19, 373 (1985). https://doi.org/10.1203/00006450-198504000-01602
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DOI: https://doi.org/10.1203/00006450-198504000-01602