ESPN 51th Annual Meeting

ESPN 2018


 
Rejection episodes, viraemia prevalence and immunosuppression switches within the first year for paediatric renal transplant recipients commenced on immunosuppression protocol of azathioprine, tacrolimus and steroids with basiliximab induction.
ZAINAB ARSLAN 1 NICK WARE 1 GRAINNE WALSH 1 HELEN JONES 1

1- EVELINA LONDON CHILDREN’S HOSPITAL, LONDON, UK
 
Introduction:

Objectives:

To look at allograft survival, rejection episodes, changes in immunosuppression and prevalence of viraemias for children on initial immunosuppression regimen of tacrolimus, azathioprine and prednisolone with basiliximab induction in the first year post-transplant.

Material and methods:

Methods:

Retrospective case note analysis undertaken on all children from single paediatric centre who underwent a renal transplant and received initial immunosuppression of prednisolone/tacrolimus/azathioprine with basiliximab induction over a 5-year period. 

Results:

Results:

80 children were transplanted between April 2012-March 2017. 32 were excluded (20 followed-up elsewhere, 12 initiated on different immunosuppression protocol).

48 children (29 male) were included in the study. Congenital anomalies of the kidney and urinary tract was the commonest underlying diagnosis (21, 44%). 36 (75%) children had living donation.  Median (range) age at time of transplant was 11(1.8-17) years.

 1-year graft survival was 98% (1 graft loss due to primary non-function).

Rejection episodes: Using Banff classification 9 (19%) children had type 1A/1B rejection; all were successfully treated with high dose steroids and MMF switch and 1 (2%) had acute antibody-mediated rejection treated with steroids, plasma exchange, intravenous immunoglobulin and MMF switch.

Viraemias (positive viral loads):  At 1 year post-transplant 19 (40%) were positive for EBV, 3(6%) for CMV and 2 (4%) for BK. 4 (8%) children were positive for EBV/CMV and 4(8%) for EBV/BK. No cases of post-transplant lymphoproliferative disease in the first year post transplant.

Immunosuppression changes: were common in the first year post transplant due to treatment of rejection, side effects of immunosuppression or infection/viraemias. 9(18%) children were not on an anti-proliferative agent at the end of first year due to high viral loads (3 had biopsy-proven BK nephropathy).

Table representing immunosuppression and viraemia status of children with significant TCM rejection episodes on initial standard immunosuppression.

Pre-transplant

Rejection Episode

1-year post transplant

Serological (IgG) Status

Donor/Recipient

Banff Category

Time post transplant (month)

Immunosuppression regimen

Viraemia status

(Positive viral load)

EBV+/-, CMV -/-

1A

1

Tac, MMF, Pred

EBV+

EBV +/-, CMV +/-

1A

9

Tac, Myfortic,Pred

Negative

EBV +/-, CMV +/-

1B/A (2 episodes)

2/3

Tac, Aza, Pred

EBV+

EBV +/+, CMV +/+

1B

1.5

Tac, MMF, Pred

Negative

EBV+/+, CMV -/-

1B

2

Tac, MMF, Pred

Negative

EBV -/-, CMV -/-

1A

2

Tac, MMF, Pred

BK+

EBV +/-, CMV -/-

1A

2

Tac, Aza,Pred

EBV, BK+

EBV +/-, CMV -/-

1A

2

Tac,MMF, Pred

EBV+

EBV +/+, CMV +/+

1A/B (2 episodes)

1/4

Tac,Myfortic,Pred

Negative

Conclusions:

Conclusion:

We report 98% graft survival, 19% significant rejection and 66% children with positive viral loads at one-year post transplant in this cohort necessitating close monitoring and tailoring of immunosuppression.