Abstract
Since June 1985 ten consecutive paediatric cadaveric renal transplant recipients (aged from 7 to 15 years) have been studied prospectively to evaluate a triple immunosuppressive regime of low-dose cyclosporin A (CyA), azathioprine (AZA) and prednisolone (PNL) with the aim of eliminating PNL from the regime within 6 months. Follow-up has been over 6–18 months. Patient and graft survival are both 100%. Median (range) serum creatinine values at 6 months were 0.09 (0.05–0.14) mmol/l (n=10) and 0.09 (0.06–0.16) mmol/l (n=5) at 12 months. Readily reversible acute rejection episodes occurred in five patients (50%); two of these episodes occurred soon after cessation of PNL. Six months post-transplantation, PNL had been discontinued in six patients (60%). After 12 months, three of five patients were still not receiving PNL. Complications included hypertension (seven patients), cytomegaloviral infections (three patients), labial herpes simplex (one patient), leucopenia (two patients), marked hirsuitism (four patients) and transient CyA nephrotoxicity (one patient). Following transplantation, all children had growth velocities greater than 5 cm/year and seven have growth patterns which suggest that “catch-up growth” may be occurring. This preliminary study shows that a triple immunosuppressive regime of low-dose CyA, AZA and PNL allows excellent patient survival, graft survival and graft function and has been associated with few complications, including a low incidence of CyA nephrotoxicity. Growth rates are very encouraging and in a high proportion of children it has been possible to discontinue PNL completely.
References
Calne RY, White DJG, Rolles K (1979) Cyclosporine A initially as the only immunosuppressant in 34 recipients of cadaveric organs. Lancet II:1033–1036
Hamilton DV, Calne RY, Evans DB, Thiru S, White DJG (1981) The effect of long-term cyclosporine in renal function. Lancet I:1218–1219
French ME, Thompson JF, Hunnisett AGW, Wood RFM, Morris PJ (1983) Impaired function of renal allografts during treatment with cyclosporine A nephrotoxicity at rejection. Transplant Proc 15:485–488
Flechner SM, van Buren CT, Kerman R, Kahan BD (1983) The nephrotoxicity of Cyclosporine in renal transplant recipients. Transplant Proc 15:2689–2694
Rizzoni G, Broyer M, Guest G, Fine R, Holliday MA (1986) Growth retardation in children with chronic renal disease: scope of the problem. Am J Kidney Dis 7: 256–261
Starzl TE, Iwatsuki S, Malarack JJ, Zitelli BJ, Gartner CJ (1982) Liver and kidney transplantation in children receiving cyclosporin A and steroids. J Pediatr 5:681–686
Klare B, Walter J, Hahn H, Emrich P (1984) Cyclosporin in renal transplantation in children. Lancet II:692
Hoyer PF, Offner G, Wonigeit K, Brodehl J, Pichlmayr R (1984) Dosage of cyclosporine A in children with renal transplants. Clin Nephrol 22:68–71
Conley SB, Flechner SM, Gilbert R, van Buren CT, Brewer E, Kahan BD (1985) Use of cyclosporine in paediatric renal transplant recipients. J Pediatr 16:45–49
Squifflet JP, Sutherland DER, Field J, Rynasiewicz JJ, Heil J, Najarian JS (1983) Synergistic immunosuppressive effect of Cyclosporin-A and Azathioprine. Transplant Proc 15:520–522
Tejani A, Khalid MH, Butt M, Khawar R, Phadke K, Adamson O, Hong J, Fusi M, Trachtman H (1986) Cyclosporine experience in renal transplantation in children. Kidney Int 30:S35-S43
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Walker, R.G., d'Apice, A.J.F., Powell, H.R. et al. Paediatric cadaveric renal transplantation. Pediatr Nephrol 1, 611–614 (1987). https://doi.org/10.1007/BF00853598
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00853598