Comparison of the immunosuppressive therapies for kidney transplantation in children

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