BACKGROUND:

Calcineuric inhibitors (CNI) avoidance or dose reduction has been proposed in pediatric kidney transplant (KTx) recipients with nephrotoxicity or neurologic side effects. Combination of CNI, imTOR, and MMF given in low doses seems to be rational. We present the outcome of a cohort treated with this regimen after 30+/-18 months.

POPULATION

12 children of 14.04±2.45 years and KTx recipients treated with FK and MMF and steroids were transferred to a triple regimen (FK, imTOR, and MMF), with reduced FK dose and without corticosteroids, at 14 (7.5-70.5) months [md(perc 25th-75th)] after transplant. 3 patients had a biopsy-proved CNI related toxicity, while 2 exhibited severe tremor, and 1 gingival hypertrophy. In 6 patients, IS was electively changed.

RESULTS

Mean FK trough levels were reduced from 9.73±1.53 to 4.18±1.47 ng/mL (p<0.001), whereas MMF levels remained stable from baseline 3.59±0.57, to the last control 3.33±0.79 (ns). Further, imTOR (sirolimus 3 patients, everolimus 9 patients) initial levels dropped from 6.9±1.13 to 3.85±0.78 (p<0.001). Interestingly, renal function remained stable in all cases with initial plasma Cr 0.87±0.2, final 0.85±0.2 mg/dl (ns), and mild to null proteinuria: 12.5±3.12 v. 8.52±3.55 mg/m2/h (p = 0.008). No rejection episodes or viral infections were detected. Donor specific antibodies detection was negative. Oral ulcers were seen in half cases, but solved after imTOR dose reduction.

COMMENTS

Our results suggest that triple IS regimen minimizing CNI may be an alternative treatment in some pediatric KTx recipients. Large series studies are needed to better know the long-term outcome.

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