Cadaver renal transplantation in children: Long‐term impact of new immunosuppressive strategies

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Abstract
We examined the effects of sequential immunosuppression on pediatric cadaveric renal transplantation. In both primary transplantation and retransplantation, graft outcome was significantly improved in patients receiving sequential immunosuppression. Allograft function, as determined by serum creatinine levels, was good in long‐term cyclosporine (CsA)‐treated patients, but tended to erode slightly over time; this erosion did not differ from that seen in allograft recipients not treated with CsA. CsA dosing and levels were higher in children 1‐12 years than in older recipients. Prednisone dosages were significantly lower in young CsA‐treated children when compared with recipients not on CsA during the 1 yr after transplantation. Hypercholesterolemia and medication non‐compliance continued to be long‐term problems under CsA immunosuppression, despite lower corticosteroid requirements. Non‐compliance was particularly common in adolescents. We conclude that dramatically improved cadaver graft outcome is achievable in children using sequential immunosuppression, but formidable obstacles remain to full medical rehabilitation.