Long-Term Outcomes of Early Conversion to Sirolimus-Based Immunosuppression in Children with Living Donor Kidney Transplants
1Pediatrics, Boston Children's Hospital, Boston, MA, 2Biostatistics and Research Design Center, Boston Children's Hospital, Boston, MA
Meeting: 2019 American Transplant Congress
Abstract number: A275.1
Keywords: Immunosuppression, Kidney transplantation, Outcome, Pediatric
Session Information
Session Name: Poster Session A: Kidney Immunosuppression: Novel Regimens and Drug Minimization
Session Type: Poster Session
Date: Saturday, June 1, 2019
Session Time: 5:30pm-7:30pm
Presentation Time: 5:30pm-7:30pm
Location: Hall C & D
*Purpose: Following kidney transplantation (KTx), calcineurin inhibitor (CNI)-based maintenance immunosuppression (IS) can be associated with nephrotoxicity and other complications including viral infections and malignancy. Mammalian target of rapamycin inhibitors, such as sirolimus (SRL), are attractive options for CNI-free IS. The aim of this study is to describe the long-term outcomes of children receiving living donor (LD) KTx on a steroid- and CNI-minimization protocol following alemtuzumab induction.
*Methods: We retrospectively reviewed consecutive LD KTx performed January 1, 2007-December 31, 2014 at our center using a protocol with alemtuzumab induction and early conversion from tacrolimus (TAC) to SRL within 3 months. Mycophenolate mofetil (MMF) was initiated at the time of KTx and steroids were discontinued when target TAC levels were achieved. Long-term graft outcomes and post-KTx complications were assessed. Inclusion criteria were age <18 years at first KTx and at least 3 years of outcomes data available.
*Results: A total of 42 children met inclusion criteria. One patient died at 6 months post-KTx from urosepsis. Of the 41 remaining children (median age 12.6 years, 56% male, 81% white), median follow-up was 5.3 years (range: 3.1-9.9 years). Graft survival was 97.6% (40/41). During the study period, 15 patients (36.6%) developed donor specific antibody. Five patients (12.2%) had episodes of acute rejection; 4 of these patients had episodes of ABMR. Eleven patients (26.8%) were switched from SRL to TAC (5 acute rejection, 2 proteinuria, 2 impaired wound healing). Nineteen patients (46.3%) switched from MMF to azathioprine, most commonly due to diarrhea. Steroid-free IS was maintained in 82.9% (34/41). Eleven patients (26.8%) required GCSF for neutropenia. One patient each developed BK viremia, CMV viremia with colitis, and PTLD. Mean eGFR at 3 and 5 years were 80 (± 31) and 75 (± 28) ml/min/1.73m2, respectively.
*Conclusions: Our results demonstrate that a steroid-avoidance protocol with early conversion from TAC to SRL for maintenance among low-risk pediatric recipients of LD KTx is associated with acceptable rates of PTLD and acute rejection, though ABMR was common in those with rejection. We found low rates of BK/CMV viremia, and excellent long-term allograft function.
To cite this abstract in AMA style:
Stotter B, Lui S, Weller E, Ganapathi L, Ferguson M, Traum A, Somers M, Rodig N. Long-Term Outcomes of Early Conversion to Sirolimus-Based Immunosuppression in Children with Living Donor Kidney Transplants [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/long-term-outcomes-of-early-conversion-to-sirolimus-based-immunosuppression-in-children-with-living-donor-kidney-transplants/. Accessed May 17, 2025.« Back to 2019 American Transplant Congress