Comparison of FK-506 and cyclosporine regimens in pediatric renal transplantation

• Published in: Pediatric nephrology (Berlin, West) West), 1994-04, Vol.8 (2), p.193-200
• Main Authors: ELLIS, D, SHAPIRO, R, JORDAN, M. L, SCANTLEBURY, V. P, GILBOA, N, HOPP, L, WEICHLER, N, TZAKIS, A. G, SIMMONS, R. L
• Format: Article
• Language: English
• Subjects: Adolescent; Biological and medical sciences; Child; Child, Preschool; Cyclosporine - administration & dosage; Cyclosporine - therapeutic use; Drug Evaluation; Female; Follow-Up Studies; Graft Rejection - drug therapy; Graft Survival; Growth - drug effects; Humans; Hypertension - drug therapy; Immunomodulators; Infant; Kidney - drug effects; Kidney - physiology; Kidney Transplantation; Male; Medical sciences; Pharmacology. Drug treatments; Tacrolimus - administration & dosage; Tacrolimus - therapeutic use
• ISSN: 0931-041X; 1432-198X
• DOI: 10.1007/BF00865477

Clinical aspects of FK-506 or cyclosporine immunosuppression regimens were evaluated in 48 consecutive pediatric renal transplant recipients. Tapering and discontinuation of prednisone was employed only in children receiving FK-506 who experienced minor or no rejection episodes during the 1st posttransplant month. At 1 year follow-up, 17 of 22 (77%) of all children with functioning allografts were receiving no prednisone (n = 13) or a mean dosage of 0.07 mg/kg per day (n = 4). During the 1st month, acute cellular rejection was more common in the FK-506 group (0.58 vs. 0.21 rejections per patient, P < 0.05) but allograft survival (92%) and renal function at 1 year posttransplant were identical in both groups. Compared with the cyclosporine regimen, FK-506 immunosuppression may be associated with a higher incidence of cytomegalovirus or reversible Epstein-Barr virus-induced lymphoproliferative disease. However, the FK-506 group had less hirsutism and gingival hypertrophy and required fewer antihypertensive medications independent of steroid use. Height standard deviation scores and weight-for-height index improved only in pre-adolescents receiving FK-506 but no prednisone (P < 0.02 and P < 0.05, respectively), but did not differ between children on FK-506 plus prednisone and those in the cyclosporine group. We conclude that the major advantages of FK-506 over cyclosporine immunosuppression are a reduced severity of hypertension and an improved cosmetic appearance which may improve long-term medical compliance. When used as monotherapy, FK-506 also shows promise in relieving the growth retardation associated with cyclosporine regimens that include prednisone.