COMPREHENSIVE REVIEW
Induction and maintenance immunosuppression in pediatric kidney transplantation—Advances and controversies
Shanthi S. Balani,
Chelsey J. Jensen,
Anne M. Kouri,
Sarah J. Kizilbash,
Shanthi S. Balani
Pediatric Nephrology, University of Minnesota, Minneapolis, MN, USA
Search for more papers by this authorChelsey J. Jensen
Solid Organ Transplant, University of Minnesota, Minneapolis, MN, USA
Search for more papers by this authorAnne M. Kouri
Pediatric Nephrology, University of Minnesota, Minneapolis, MN, USA
Search for more papers by this authorCorresponding Author
Sarah J. Kizilbash
Pediatric Nephrology, University of Minnesota, Minneapolis, MN, USA
Correspondence
Sarah J. Kizilbash, University of Minnesota, 2450 Riverside Avenue, 55454 Minneapolis, MN, USA.
Email: [email protected]
Search for more papers by this authorShanthi S. Balani,
Chelsey J. Jensen,
Anne M. Kouri,
Sarah J. Kizilbash,
Shanthi S. Balani
Pediatric Nephrology, University of Minnesota, Minneapolis, MN, USA
Search for more papers by this authorChelsey J. Jensen
Solid Organ Transplant, University of Minnesota, Minneapolis, MN, USA
Search for more papers by this authorAnne M. Kouri
Pediatric Nephrology, University of Minnesota, Minneapolis, MN, USA
Search for more papers by this authorCorresponding Author
Sarah J. Kizilbash
Pediatric Nephrology, University of Minnesota, Minneapolis, MN, USA
Correspondence
Sarah J. Kizilbash, University of Minnesota, 2450 Riverside Avenue, 55454 Minneapolis, MN, USA.
Email: [email protected]
Search for more papers by this authorAbstract
Advances in immunosuppression have improved graft survival in pediatric kidney transplant recipients; however, treatment-related toxicities need to be balanced against the possibility of graft rejection. Several immunosuppressive agents are available for use in transplant recipients; however, the optimal combinations of agents remain unclear, resulting in variations in institutional protocols. Lymphocyte-depleting antibodies, specifically ATG, are the most common induction agent used for pediatric kidney transplantation in the US. Basiliximab may be used for induction in immunologically low-risk children; however, pediatric data are scarce. CNIs and antiproliferative agents (mostly Tac and mycophenolate in recent years) constitute the backbone of maintenance immunosuppression. Steroid-avoidance maintenance regimens remain controversial. Belatacept and mTOR inhibitors are used in children under specific circumstances such as non-adherence or CNI toxicity. This article reviews the indications, mechanism of action, efficacy, dosing, and side effect profiles of various immunosuppressive agents available for pediatric kidney transplantation.
Open Research
DATA AVAILABILITY STATEMENT
As this is a review article, data availability statement is not applicable.
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