Immunosuppression in Pediatric Kidney Transplant Patients

Sang-il Min; Ahram Han; Chanjoong Choi; Yi Kim Song; Gyung Kang Hee; Soo Ha Il; Jongwon Ha

doi:10.4285/jkstn.2015.29.1.1

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Min, Han, Choi, Song, Hee, Il, and Ha: Immunosuppression in Pediatric Kidney Transplant Patients

Review Article

J Korean Soc Transplant 2015;29(1):1-8.

Published online: 10 March 2015

DOI: https://doi.org/10.4285/jkstn.2015.29.1.1

Immunosuppression in Pediatric Kidney Transplant Patients

Sang-il Min, M.D.¹, Ahram Han, M.D.¹, Chanjoong Choi, M.D.¹, Yi Kim Song, M.D.¹, Gyung Kang Hee, M.D.², Soo Ha Il, M.D.², Jongwon Ha, M.D.¹

¹Departments of Surgery, Seoul National University College of Medicine, Seoul, Korea

²Pediatrics, Seoul National University College of Medicine, Seoul, Korea

Corresponding author: Jongwon Ha, Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro Jongno-gu, Seoul 110-744, Korea Tel: 82-2-2072-2991, Fax: 82-2-766-3975 E-mail: jwhamd@snu.ac.kr

Received 4 March 2015 Revised 31 March 2015 Accepted 31 March 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Over the last two decades, newer immunosuppressive agents have been introduced in the field of solid organ transplantation, and provided better graft and patient outcome. A wider range of immunosuppressants available to transplant physicians have resulted in improved therapeutic strategies to offer the combinations of medications with non-overlapping toxicities and more suitable immunosuppression. However, only a few clinical trials of new immunosuppressants have been conducted in pediatric patients. This review will discuss the cutting-edge strategy of immunosuppression in children and the current status of new immunosuppressive agents in pre- and post-transplant management to prevent kidney allograft rejection.

Keywords: Kidney transplantation, Immunosuppression, Child

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Fig. 1.

Immunosuppression use in pediatric kidney transplantation in Korea. National Survey data (1999∼2000). Adapted from reference [8]. (A) Calcineurin inhivitor (at transplant), (B) Induction agents, (C) Anti-matolites (at transplant) and (D) Steroids.

Fig. 2.

(A) A typical concentration-time curve and (B) Correlation of AUC_0–24 and C _min of twice-daily tacrolimus formulation (Prograf). Adapted from Fig. 2 of reference [31].

Fig. 3.

Individual variation of tacrolimus trough concentration after mg:mg conversion from twice-daily tacrolimus formulation (Prograf) to once-daily tacrolimus formulation (Advagraf). Adapted from Fig. S1 of reference [31].

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