Subclinical Rejection and Immunosuppression in Pediatric Kidney Transplant Recipients : Single Centre Study

2021 ◽  
Vol 14 (3) ◽  
pp. 1149-1159
Author(s):  
Fatina I Fadel ◽  
Abeer M Nour ElDin Abd ElBaky ◽  
Mohamed A Abdel Mawla ◽  
Wesam I Moustafa ◽  
Gamal Eldin Saadi ◽  
...  
Keyword(s):  
Renal Transplant ◽  
Triple Therapy ◽  
Low Dose ◽  
Case Series ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Post Transplantation ◽  
Number Of Patients ◽  
Pediatric Renal Transplant ◽  
Subclinical Rejection

Background: By the time of histological confirmation of rejection is achieved, renal scarring may for treatment as a realistic option . This study aims to study the subclinical pathological graft data and to evaluate the histopathological impact of different immunosuppression protocols in pediatric renal transplant recipients. Methods: This is a case series that included twenty living donor renal transplant recipients. All included cases received the classic triple immunotherapy for at least one month post-transplantation [Steroids, calconurine inhibitors (CNI), and mycofenlolic mofetile (MMF)]. Based on their immunological risk stratification; included cases were divided into 2 groups: group (A) continued on CNI based triple therapy protocol; group (B) shifted to evirolimus /low dose CNI protocol. Surveillance biopsies were done for all cases at one and four month post-transplantation. Results: One and four month biopsies revealed subclinical rejection (including borderline changes) in 4 (20%) cases and 6 (30%) cases respectively. The number of patients received tacrolimus/MMF therapy significantly increased (p=0.02) while that of patients on everloimus/low dose CNI significantly decreased (p=0.014) due to drug modifications based on four month surveillance biopsy data. Conclusion: Subclinical rejection is not uncommon in pediatric renal graft recipients which makes surveillance biopsy might be of help. Early usage of evirolimus/low CNI protocol is associated with higher rejection rate than triple therapy.

scholarly journals Mycophenolic Acid Concentration on Vietnamese Renal Transplant Recipients

2021 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Dung Thi Mai Dung ◽  
An Phan Hai Ha ◽  
Dong Van Le ◽  
Lan Thi Phuong Dam ◽  
Thuan Quang Huynh
Keyword(s):  
Renal Transplant ◽  
Mycophenolic Acid ◽  
Calcineurin Inhibitor ◽  
Drug Level ◽  
Therapeutic Drug ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Post Transplantation ◽  
Kidney Recipients ◽  
Number Of Patients

Background: Kidney recipients often use a calcineurin inhibitor and a proliferation inhibitor after transplantation. The therapeutic drug monitoring for calcineurin inhibitor is more simple and feasible in clinical than proliferation inhibitor. In Vietnam, mycophenolic acid is a popular proliferation inhibitor used for transplantation patients. Although therapeutic mycophenolic acid monitoring is so important in treating kidney transplantation, the monitoring is still difficult to execute in Vietnam. Objectives: This study aimed to determine the MPA concentration on Vietnamese renal transplant recipients. Methods: This observational study was conducted on 35 adult kidney recipients to evaluate the MPA concentration at five sampling time points (predose, 1, 2, 3, and 6 hours) on day 3, day 10, and month 6 after transplantation. Results: Plasma MPA trough levels (C0) were 2.32 ± 1.47;1.58 ± 1.39; 2.29 ± 1.4 mg/L and the MPA-AUC0-12 h values were 50.1 ± 20.4; 41.9 ± 14.5; 60.3 ± 25.9 mg.h/L on day 3, day 10, and month 6. The number of patients who reached MPA-AUC0-12 h values of 30 - 60 mg.h/L was 18 (51.4%), 23 (65.7%) and 17 (51.5%) on day 3, day 10, and month 6, respectively. The number of patients who achieved the MPA C0 values of 1.5 - 2.5 mg/L was 15 (42.9 %), 14 (40%), and 10 (30.3%) on day 3, day 10, and month 6, respectively; and the linear correlation coefficients between AUC0-12 h and C0 were 0.652, 0.415, and 0.752, respectively. Conclusions: In renal transplant patients, the MPA-AUC0-12 h was lower on day 3 and day 10 post-transplantation than month 6 for the half dose of MMF or MPS. Therefore, MPA therapeutic drug level should be monitored usually in transplantation patients who use MPA.

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