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NDT Advance Access originally published online on July 12, 2006
Nephrology Dialysis Transplantation 2006 21(10):2930-2937; doi:10.1093/ndt/gfl279
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© The Author [2006]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Stable graft function after reduction of calcineurin inhibitor dosage in paediatric kidney transplant patients

Christian Plank1,*, Kerstin Benz1,*, Kerstin Amann2, Kai-Dietrich Nüsken1, Katalin Dittrich1, Wolfgang Rascher1, Katja Sauerstein1, Anja Stuppy1, Bernd Klare3 and Jörg Dötsch1,

1Klinik für Kinder und Jugendliche, 2Pathologisches Institut, Universität Erlangen-Nürnberg and 3Kinderklinik München-Schwabing, Germany

Correspondence and offprint requests to: Jörg Dötsch, MD, Klinik für Kinder und Jugendliche, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestrasse 15, 91054 Erlangen, Germany. Email: joerg.doetsch{at}kinder.imed.uni-erlangen.de

Background. Chronic calcineurin inhibitor (CNI) toxicity contributes to the development and progression of chronic allograft nephropathy (CAN), which is still the major cause of transplant dysfunction and graft loss. Reduction in dosage of CNI may delay the development of CAN, leading to longer graft survival.

Methods. Therefore, 19 paediatric kidney transplant patients under immunosuppressive therapy with CNI (12/19 ciclosporin A, CSA, 7/19 tacrolimus, Tac), mycophenolat mofetil and some patients on steroids were included in a prospective study. Over a period of 9 months CNI dosage was stepwise reduced from CSA trough levels of 100–150 ng/ml to 50–70 ng/ml and Tac trough levels of 5–8 ng/ml to 2–3 ng/ml, respectively.

Results. Glomerular filtration rate was stabilized in patients after CSA and Tac reduction. One borderline rejection occurred in a patient prior to reduction of Tac. In patients on CSA, one interstitial cellular rejection (BANFF IA) was noted. Reduction of CNI had no significant effects on blood pressure, lipid status and the infection frequency.

Conclusions. In paediatric kidney transplant patients, reduction of CNI down to low trough levels stabilizes renal function. However, the risk of acute rejection episodes may be increased. Therefore, further studies based on protocol biopsies within a randomized trial are warranted.

Keywords: calcineurin inhibitor toxicity; ciclosporin; paediatric renal transplantation; tacrolimus

*The authors wish it to be known that, in their opinion, the first two authors contributed equally to this work.


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