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NDT Advance Access published online on July 12, 2006
Nephrology Dialysis Transplantation, 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
Received November 3, 2005
Accepted April 24, 2006

Original Article

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

Christian Plank 1, Kerstin Benz 1, Kerstin Amann 2, Kai-Dietrich Nüsken 1, Katalin Dittrich 1, Wolfgang Rascher 1, Katja Sauerstein 1, Anja Stuppy 1, Bernd Klare 3, and Jörg Dötsch 1 *

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

* To whom correspondence should be addressed.
Jörg Dötsch, E-mail: joerg.doetsch{at}kinder.imed.uni-erlangen.de



  Abstract

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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