Outcomes of two‐drug maintenance immunosuppression for pediatric renal transplantation: 10‐yr follow‐up in a single center. (2nd November 2015) - Michael, Mini
Abstract: Minimizing IS to reduce side effects without compromising long‐term renal transplant survival is the goal of all IS protocols. We conducted a retrospective study of pediatric renal transplants performed August 1988 to July 2008 and treated with two‐drug maintenance therapy by one of three protocols: prednisone/cyclosporine without induction (SB) or with daclizumab induction (SBI), or tacrolimus/mycophenolate with daclizumab induction (SF). Kaplan–Meier survival curves were used to determine graft and patient survival at one, three, five, and 10 yr. Associations between graft survival and patient/transplant characteristics were determined using log‐rank test and CPH model adjusting for treatment group. About 208 patients were included in the analysis (96 SB, 97 SBI, 15 SF; 148 DD, 60 LD, 37 pre‐emptive). Overall graft and patient survival at one, three, five, and 10 yr were similar to the previously published results of pediatric renal transplants in similar years treated predominantly with three‐drug maintenance therapy (https://web.emmes.com/study/ped/annlrept/2010 ). Only biopsy‐proven TG was significantly associated with worse graft survival (HR 11.5, 95% CI: 3.4, 38.7). Malignancy rate was low (2.4%) with little PTLD (0.5%). Few opportunistic or other infections occurred (<5% patients). Minimizing IS to a two‐drug maintenance regimen had no adverse effect on long‐term transplant outcome and had low malignancy and infection rates.