ESPN 53rd Annual Meeting

ESPN 2021


 
CHANGES IN IMMUNOSUPPRESSIVE MEDICATION AFTER KIDNEY TRANSPLANTATION
HENNA PUUSAARI 1 Anna Bjerre 2 Hannu Jalanko 3 Lars Wennberg 4 Søren Sørensen Schwartz 5 Susanne Westphal Ladfors 6 Helle Charlotte Thiesson 7 Zivile Bekassy 8 Gianni Celsi 9 Timo Jahnukainen 3

1- TAMPERE UNIVERSITY HOSPITAL, DEPARTMENT OF PEDIATRICS, PEDIATRIC NEPHROLOGY, TAMPERE, FINLAND.
2- Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway.
3- Children’s Hospital and Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Finland.
4- Department of Transplantation Surgery, Karolinska University Hospital, Stockholm, Sweden.
5- Department of Nephrology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
6- Department of Pediatrics. The Queen Silvia Children’s Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden.
7- Department of Nephrology, Odense University Hospital, Odense, Denmark.
8- Department of Pediatric Nephrology, Skane University Hospital, Lund, Sweden.
9- Dept of Pediatric, Uppsala University Hospital, Uppsala, Sweden.
 
Introduction:

 There are data available from both single center studies and large registries on the initial immunosuppression in pediatric kidney transplant (KT) recipients. However, the knowledge of changes in maintenance immunosuppression is scarce. In the present study, we evaluated changes in maintenance immunosuppressive medication in pediatric KT recipients in the Nordic countries. 

Material and methods:

 Data were collected retrospectively from the Scandiatransplant pediatric registry (Nordic Pediatric Renal Transplantation Study Group, NPRTSG) including all pediatric KTs in the Nordic countries between the years 2005 and 2016. The inclusion criteria were age below 16 years at transplantation and a post-transplant follow-up time of at least two years.

Results:

 Of the 482 transplanted children, 345 patients met the inclusion criteria. A change in maintenance immunosuppression was recorded in 161 patients (47.1%), occurring during the first post-transplant year in 44.7% of these patients. The most common change was conversion of cyclosporine (CsA) to tacrolimus (Tac) (41.6% of all changes). The age distribution was similar in patients with CsA to Tac conversion as compared to those continuing on CsA. CsA was switched to Tac in 66.7%, 78.6% and 75.7% of the cases under two years old, two to five years old, and five to sixteen years old, respectively. Otherwise, initial immunosuppression was likely to remain unchanged. Concurrent rejection was present in 17.5% of all cases with immunosuppression change and in 23.9% of the cases when CsA was converted to Tac. There were 10 recorded PTLD  cases, eight cases with tacrolimus as an initial calcineurin inhibitor.

 

Conclusions:

 The majority of patients with CsA as an initial immunosuppression were converted to Tac during the follow up. Rejection was the reason for drug change in less than 20% of the cases.