Shapiro, R and Scantlebury, VP and Jordan, ML and Vivas, C and Gritsch, HA and Ellis, D and Gilboa, N and Lombardozzi-Lane, S and Irish, W and Fung, JJ and Hakala, TR and Simmons, RL and Starzl, TE
(1996)
Tacrolimus in pediatric renal transplantation.
Transplantation, 62 (12).
1752 - 1758.
ISSN 0041-1337
Abstract
Tacrolimus was used as the primary immunosuppressive agent in 69 pediatric renal transplantations between December 17, 1989, and June 30, 1995. Children undergoing concomitant or prior liver and/or intestinal transplantation were excluded from analysis. The mean recipient age was 10.3±5.0 years (range, 0.7-17.5 years). Seventeen (24.6%) children were undergoing retransplantation, and six (8.7%) had a panel reactive antibody level of 40% or higher. Thirty-nine (57%) cases were with cadaveric kidneys, and 30 (43%) were with living donors. The mean donor age was 28.0±14.7 years (range, 1.0-50.0 years), and the mean cold ischemia time for the cadaveric kidneys was 27.0±9.4 hr. The antigen match was 2.7±1.2, and the mismatch was 3.1±1.2. All patients received tacrolimus and steroids, without antibody induction, and 26% received azathioprine as well. The mean follow-up was 32±20 months. One- and 4-year actuarial patient survival rates were 100% and 95%. One- and 4-year actuarial graft survival rates were 99% and 85%. The mean serum creatinine level was 1.2±0.8 mg/dl, and the calculated creatinine clearance was 82±26 ml/min/1.73 m2. The mean tacrolimus dose was 0.22±0.14 mg/kg/day, and the level was 9.5±4.8 ng/ml. The mean prednisone dose was 2.1±4.9 mg/day (0.07±0.17 mg/kg/day), and 73% of successfully transplanted children were off prednisone. Seventy-nine percent were not taking any antihypertensive medications. The mean serum cholesterol level was 158±54 mg/dl. The incidence of delayed graft function was 4.3%. The incidence of rejection was 49%, and the incidence of steroid-resistant rejection was 6%. The incidence of rejection decreased to 27% in the most recent 26 cases (January 1994 through June 1995). The incidence of new-onset diabetes was 10.1%; six of the seven affected children were able to be weaned off insulin. The incidence of cytomegalovirus disease was 13%, and that of posttransplant lymphoproliferative disorder was 10%; the incidence of posttransplant lymphoproliferative disorder in the last 40 transplants was 5% (two cases). All of the children who developed posttransplant lymphoproliferative disorder are alive and have functioning allografts. Based on this data, we believe that tacrolimus is a superior immunosuppressive agent in pediatric renal transplant patients, with excellent short- and medium-term patient and graft survival, an ability to withdraw steroids in the majority of patients, and, with more experience, a decreasing rate of rejection and vital complications.
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| Item Type: |
Article
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| Status: |
Published |
| Creators/Authors: |
| Creators | Email | Pitt Username | ORCID  |
|---|
| Shapiro, R | | | | | Scantlebury, VP | | | | | Jordan, ML | | | | | Vivas, C | | | | | Gritsch, HA | | | | | Ellis, D | | | | | Gilboa, N | | | | | Lombardozzi-Lane, S | | | | | Irish, W | | | | | Fung, JJ | | | | | Hakala, TR | | | | | Simmons, RL | | | | | Starzl, TE | tes11@pitt.edu | TES11 | |
|
| Centers: |
Other Centers, Institutes, Offices, or Units > Thomas E. Starzl Transplantation Institute |
| Date: |
27 December 1996 |
| Date Type: |
Publication |
| Journal or Publication Title: |
Transplantation |
| Volume: |
62 |
| Number: |
12 |
| Page Range: |
1752 - 1758 |
| DOI or Unique Handle: |
10.1097/00007890-199612270-00010 |
| Institution: |
University of Pittsburgh |
| Refereed: |
Yes |
| ISSN: |
0041-1337 |
| Other ID: |
uls-drl:31735062134196, Starzl CV No. 1962 |
| Date Deposited: |
08 Apr 2010 17:33 |
| Last Modified: |
22 Jun 2021 11:55 |
| URI: |
http://d-scholarship.pitt.edu/id/eprint/5348 |
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