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Immunosuppression in Pediatric Kidney Transplantation

Pediatric Kidney Disease, Page: 1849-1886
2023
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Book Chapter Description

Because it is currently not possible to induce specific tolerance, transplantation requires immunosuppressive therapies. The goal is to use immunosuppressive agents that are potent, selective, and reversible, with reliable delivery and long-term safety. A careful balance is required to find the dose that prevents rejection of the graft, while minimizing the risks of over-immunosuppression leading to infection and cancer. The common immunosuppressive agents used in pediatric renal transplantation include the glucocorticoids, azathioprine, mycophenolate mofetil, the calcineurin inhibitors tacrolimus and ciclosporin, the mammalian target of rapamycin inhibitors sirolimus (SRL) and everolimus, and antibodies to cell surface antigens on lymphocytes (antithymocyte globulin), anti-CD25 antibodies (anti-interleukin-2 receptor antibodies), alemtuzumab (a humanized anti-CD52 pan-lymphocytic monoclonal antibody) and belatacept, a costimulation blocker of T cells. This chapter focuses on these agents and how they inhibit the immune response. Although data from adult renal transplantation trials are used to help guide management decisions in pediatric patients, immunosuppression often must be modified because of the unique clinical effects of some of these agents in children, including their impact on growth and development.

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