Comparison of the immunosuppressive therapies for kidney transplantation in children
YANG Shun-liang, WU Wei-zhen, LIN Wen-hong, XU Ting-zhao, CAI Jin-quan, TAO Xiao-qin, WANG Qing-hua, WANG Dong, GAO Xia, TAN Jian-ming
Published 2008-02-15
Cite as Chin J Pediatr Surg, 2008,29(02): 97-100. DOI: 10.3760/cma.j.issn.0253-3006.2008.02.011
Abstract
Objective To explore the efficacy and safety of the different immunosuppressive regimens on the long-term survival of renal allografts in pediatric recipients.Methods The clinical data of 34 transplanted patients were analyzed.The recipients were divided into five groups:group A received cyclosporine and steroid;group B received cyclosporine,azathioprine and steroid;group C received cyclosporine,mycophenolante mofetil(MMF)and steroid;group D received Tacrolimus,azathioprine and steroid:and group E received Tacrolimus,MMF and steroid.Results The recipient/graft survival rates after 1,3,and 5 years were 100%/97%,91%/87.8% and 84.4%/80.9% respectively.The survival rates of Cyclosporine-based and Tacrolimus-based immunosuppression at 1,3 and 5 year were 48.5%/51.5%,60%/40% and 53.6/43.4% respectively.The survival rates for azathioprine and MMF group were 21.2%/78.8%,23.3%/70%,32.1%/60.7% respectively.The dosage of Cyclosporine was 2~3 mg·kg-1·d-1,with the trough levels between 100 ng/mL to 150 ng/mL.When Tacrolimus was used,the dosage was 0.03~O.05 mg·kg-1·d-1,with its trough level rangmg from 1.5 ng/mL to 3 ng/mL.There were no significant difference of the dosage and blood for Cyclos porine or Tacrolimus at different period.The dosage of MMF was 10 mg·kg-1·d-1,and prednisone was 5~1 0 mg/d.The incompliance rate was 30%,and 5 patients lost their renal grafts,of which one suffered from rejection and four died with normal renal function,2 from pulmonary infection,and 2 from drug induced liver impairment.The other complications included:hypertension 35.7%,hyper lipidemia 28.6%,infection 17.9%,gingival hyperplasia 14.3%,hypertrichiasis 10.7%,and diabetes mellitus 3.6%. Conclusions Cyctosporine/Tacrolimus,MMF,plus prednisone regimen is the most effective immunosuppressive therapy for pediatric renal recipients.
Key words:
Kidney transplantation; Immunosuppressive agents; Survival rate
Contributor Information
YANG Shun-liang
Organ Transplant Institute of PLA,Department of Urology,Fuzhou General Hospital,Nanjin Military Command,Fuzhou 350025,China
WU Wei-zhen
Organ Transplant Institute of PLA,Department of Urology,Fuzhou General Hospital,Nanjin Military Command,Fuzhou 350025,China
LIN Wen-hong
Organ Transplant Institute of PLA,Department of Urology,Fuzhou General Hospital,Nanjin Military Command,Fuzhou 350025,China
XU Ting-zhao
Organ Transplant Institute of PLA,Department of Urology,Fuzhou General Hospital,Nanjin Military Command,Fuzhou 350025,China
CAI Jin-quan
Organ Transplant Institute of PLA,Department of Urology,Fuzhou General Hospital,Nanjin Military Command,Fuzhou 350025,China
TAO Xiao-qin
Organ Transplant Institute of PLA,Department of Urology,Fuzhou General Hospital,Nanjin Military Command,Fuzhou 350025,China
WANG Qing-hua
Organ Transplant Institute of PLA,Department of Urology,Fuzhou General Hospital,Nanjin Military Command,Fuzhou 350025,China
WANG Dong
Organ Transplant Institute of PLA,Department of Urology,Fuzhou General Hospital,Nanjin Military Command,Fuzhou 350025,China
GAO Xia
Organ Transplant Institute of PLA,Department of Urology,Fuzhou General Hospital,Nanjin Military Command,Fuzhou 350025,China
TAN Jian-ming
Organ Transplant Institute of PLA,Department of Urology,Fuzhou General Hospital,Nanjin Military Command,Fuzhou 350025,China