Changes in maintenance immunosuppression after pediatric kidney transplantation-a report from the Nordic pediatric kidney transplantation registry.

BACKGROUND

Few studies are available on changes in maintenance immunosuppression after pediatric kidney transplantation (KT). This is a retrospective registry analysis of the long-term medication modifications in the Nordic countries.

METHODS

All pediatric KT recipients transplanted between the years 2005 and 2016 were identified from the Scandiatransplant registry. Of the 482 patients, 345 met the inclusion criteria: age below 16 years at KT and at least 2 years post-transplant follow-up.

RESULTS

A change in maintenance immunosuppression occurred in 160 patients (46.4%) at 2.0 (interquartile range 1.0-3.0) years median time from KT. The most common change (35.8%) was switching cyclosporine A (CsA) to tacrolimus (Tac). Initial CsA treatment was modified significantly more often compared to Tac (72.0% vs. 6.0%; p < 0.001). Modifications of mycophenolate mofetil (MMF) were observed more often in recipients aged < 2 (75.0%) and 2-5 (55.6%) years compared with 5-16 years (13.2%; p < 0.001); particularly, MMF discontinuation was common (< 2 years 45.8% and 2-5 years 38.9%). Otherwise, initial immunosuppression remained mainly unchanged. The main reasons for changing CsA to Tac were cosmetic side effects (26.2%), rejections (26.2%), and declining graft function (23.0%). In case of rejection or declining graft function, CsA-to-Tac conversion slowed the decrease in measured glomerular filtration rate. MMF modifications did not affect graft survival from 2 to 7.5 years post-transplant.

CONCLUSIONS

Maintenance immunosuppression is modified in almost half of pediatric KT recipients. Particularly, CsA conversion to Tac and young recipients' MMF modifications are common.