Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2021 Nov;25(7):e14077.
doi: 10.1111/petr.14077. Epub 2021 Jul 3.

Induction and maintenance immunosuppression in pediatric kidney transplantation-Advances and controversies

Shanthi S Balani  1 , Chelsey J Jensen  2 , Anne M Kouri  1 , Sarah J Kizilbash  1
Affiliations
Review

Induction and maintenance immunosuppression in pediatric kidney transplantation-Advances and controversies

Shanthi S Balani et al. Pediatr Transplant. 2021 Nov.

Abstract

Advances in immunosuppression have improved graft survival in pediatric kidney transplant recipients; however, treatment-related toxicities need to be balanced against the possibility of graft rejection. Several immunosuppressive agents are available for use in transplant recipients; however, the optimal combinations of agents remain unclear, resulting in variations in institutional protocols. Lymphocyte-depleting antibodies, specifically ATG, are the most common induction agent used for pediatric kidney transplantation in the US. Basiliximab may be used for induction in immunologically low-risk children; however, pediatric data are scarce. CNIs and antiproliferative agents (mostly Tac and mycophenolate in recent years) constitute the backbone of maintenance immunosuppression. Steroid-avoidance maintenance regimens remain controversial. Belatacept and mTOR inhibitors are used in children under specific circumstances such as non-adherence or CNI toxicity. This article reviews the indications, mechanism of action, efficacy, dosing, and side effect profiles of various immunosuppressive agents available for pediatric kidney transplantation.

Keywords: immunosuppressive treatment; pediatric kidney transplantation.

PubMed Disclaimer

References

REFERENCES

    1. Barker CF, Markmann JF. Historical overview of transplantation. Cold Spring Harb Perspect Med. 2013;3:a014977.
    1. Najarian JS, Simmons Rl, Tallest MB, et al. Renal transplantation in infants and children. Ann Surg. 1971;174:583-601.
    1. Hart A, Smith JM, Skeans MA. OPTN/SRTR 2018 annual data report: preface. Am J Transplant. 2020;20(Suppl s1):20-130. https://doi.org/10.1111/ajt.15672
    1. Kidney Disease: Improving Global Outcomes (KDIGO) Transplant Work Group. KDIGO clinical practice guideline for the care of kidney transplant recipients. Am J Transplant. 2009;9(Suppl 3):S1-S155.
    1. Rhen T, Cidlowski JA. Antiinflammatory action of glucocorticoids-new mechanisms for old drugs. N Engl J Med. 2005;353:1711-1723.

MeSH terms

Substances

LinkOut - more resources