Improved long-term graft function in pediatric transplant renal recipients with chronic allograft nephropathy |
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Authors: | Kerecuk Larissa Horsfield Catherine Taylor Judy |
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Affiliation: | Department of Paediatric Nephrology, Evelina Children's Hospital;, Department of Histopathology, Guy's and St Thomas' NHS Foundation Trust, London, UK |
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Abstract: | Abstract: CAN is the leading cause of graft loss in pediatric renal transplant recipients. A retrospective single centre analysis of pediatric transplant patients with CAN treated with MMF in conjunction with CNI minimisation/withdrawal is reported. 35 children were successfully started on MMF. The mean age at transplant was 7.9 ± 0.1 years. MMF was introduced 3.5 ± 0.1 years after transplantation and patients were followed up for a mean of 32.2 ± 0.5 months. CAN was confirmed on biopsy in 31 patients. CNI was stopped in 23 patients at a mean time of 16.5 ± 0.6 months after MMF introduction and minimised in the remaining patients. Prior to MMF introduction, GFR was deteriorating by 21.6 ± 0.07 ml/min/1.73 m2/yr. After MMF, there was an overall improvement in GFR of 4.0 ± 0.03 ml/min/1.73 m2/yr. This was most marked in the first six months when the GFR improved by 20.8 ± 0.06 ml/min/1.73 m2/day. Mean acute rejection episode rate prior to MMF was significantly reduced after MMF introduction. MMF was discontinued in a total of 4 patients due to adverse effects. CNI minimisation/withdrawal with MMF introduction is safe and leads to significant initial improvement with subsequent stabilisation of GFR and improved long term graft survival in pediatric renal transplant recipients with CAN. |
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Keywords: | pediatric renal transplantation calcineurin inhibitors chronic allograft nephropathy blood pressure MMF rejection |
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