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Protocol biopsies in pediatric renal transplant recipients on cyclosporine versus tacrolimus-based immunosuppression

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Abstract

Background

Protocol biopsies can detect subclinical rejection and early signs of calcineurin inhibitor-induced nephrotoxicity.

Methods

In a prospective study, protocol biopsies 3 and 12 months after transplant in transplanted children from two centers were studied. One center used cyclosporine (CsA)-based immunosuppression and the other center used tacrolimus. Patients were on CsA (n = 26, group 1) or on tacrolimus (n = 10, group 2). Patients received basiliximab induction, mycophenolate mofetil, and prednisone.

Results

In patients on CsA, 26 kidney biopsies were performed during the 6 months after transplantation. Eighteen protocol biopsies were performed at 3 months post transplant; 13 were normal and five showed rejection (two borderline and three Banff II rejections). Eight biopsies were motivated by an increase of serum creatinine; four were normal and four revealed signs of acute rejection (two borderline and two Banff II). Twelve protocol biopsies were performed after 12 months; all were normal. For patients on tacrolimus (n = 10), ten protocol transplant biopsies were performed at 3 months post-transplant; none showed signs of rejection. No biopsy was performed for an increase of serum creatinine. There were no differences in patient age, number of human leukocyteantigen (HLA) incompatibilities, or other patient characteristics.

Conclusions

Patients on tacrolimus had less acute rejection episodes detected on protocol biopsies 3 months after transplant. Protocol biopsies seem to play an important role in the detection of subclinical rejection in patients on CsA.

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Authors and Affiliations

  1. Service de Néphrologie et Dialyses Pédiatrique, Hôpital Armand Trousseau, Avenue du Docteur Netter, 75012, Paris, France

    Bilal Aoun, Renata Vitkevic, Hala Wannous, Christine Azema & Tim Ulinski

  2. Université Pierre et Marie Curie (UMPC), Paris 6, Paris, France

    Patrice Callard, Isabelle Brocheriou & Tim Ulinski

  3. Service de Pédiatrie-Néphrologie, Médecine interne et Hypertension, Hôpital des Enfants, Toulouse, France

    Stéphane Decramer & Flavio Bandin

  4. Service d’Anatomie pathologique, Hôpital, Tenon, Paris, France

    Patrice Callard & Isabelle Brocheriou

Authors
  1. Bilal Aoun
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  2. Stéphane Decramer
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  3. Renata Vitkevic
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  4. Hala Wannous
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  5. Flavio Bandin
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  6. Christine Azema
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  7. Patrice Callard
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  8. Isabelle Brocheriou
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  9. Tim Ulinski
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Corresponding author

Correspondence to Tim Ulinski.

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Aoun, B., Decramer, S., Vitkevic, R. et al. Protocol biopsies in pediatric renal transplant recipients on cyclosporine versus tacrolimus-based immunosuppression. Pediatr Nephrol 28, 493–498 (2013). https://doi.org/10.1007/s00467-012-2330-6

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  • DOI: https://doi.org/10.1007/s00467-012-2330-6

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