TACROLIMUS IN PEDIATRIC RENAL-TRANSPLANTATION

Tacrolimus was used as the primary immunosuppressive agent in 69 pedia tric renal transplantations between December 17, 1989, and June 30, 19 95. Children undergoing concomitant or prior liver and/or intestinal t ransplantation 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 ca daveric 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 i schemia 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 rece ived tacrolimus and steroids, without antibody induction, and 26% rece ived azathioprine as well, The mean follow-up was 32+/-20 months. One- and 4-year actuarial patient survival rates were 100% and 95%. One- a nd 4-year actuarial graft survival rates were 99% and 85%. The mean se rum creatinine level was 1.2+/-0.8 mg/dl, and the calculated creatinin e clearance was 82+/-26 ml/min/1.73 m(2). The mean tacrolimus dose was 0.22+/-0.14 mg/kg/day, and the level was 9.5+/-4.8 ng/ml. The mean pr ednisone 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 ser um cholesterol level was 158+/-54 mg/dl, The incidence of delayed graf t function was 4.3%. The incidence of rejection was 49%, and the incid ence of steroid-resistant rejection was 6%. The incidence of rejection decreased to 27% in the most recent 26 cases (January 1994 through Ju ne 1995), The incidence of new-onset diabetes was 10.1%; six of the se ven affected children were able to be weaned off insulin. The incidenc e of cytomegalovirus disease was 13%, and that of posttransplant lymph oproliferative disorder was 10%; the incidence of posttransplant lymph oproliferative 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 th e majority of patients, and, with more experience, a decreasing rate o f rejection and viral complications.