Immunosuppressive drugs and major complications in pediatric renal transplantation

• Main Authors: Guerrero-Tinoco, Gustavo Adolfo, Villafañe-Bermúdez, Douglas Ramón, Vélez-Echeverri, Catalina
• Format: Article
• Language: Spanish
• Published: Universidad de Antioquia 2017-01-01
• Series: Iatreia
• Subjects: Immunosuppressive Agents; Pediatric; Rejection; Renal Transplantation
• Online Access: http://aprendeenlinea.udea.edu.co/revistas/index.php/iatreia/article/view/26136/20783992

Pediatric renal transplantation is the treatment of choice in children with chronic kidney disease. Many agents are available for immunosuppressive therapy, which are used in two different regimes: first for the induction phase, and then for maintenance. There are two strategies for reducing the risk of renal graft rejection: the first is the use of high doses of conventional immunosuppressive agents, and the second is the use in the induction phase of monoclonal or polyclonal antibodies against antigens of T cells. The two most frequently used polyclonal antibodies are horse and rabbit anti-thymocyte globulins, ATGAM and rATG, respectively. The most frequently used monoclonal antibodies are those against IL-2 receptor (basiliximab and daclizumab) and the one against antigen CD52 (alemtuzumab). Maintenance therapy is a scheme that combines the use of three conventional immunosuppressive drugs: glucocorticoids, calcineurin inhibitors, mTOR inhibitors and antiproliferatives. The following are among the major complications of renal transplantation: acute graft rejection, viral infection (cytomegalovirus and BK polyomavirus) and appearance of PTLD (posttransplant lymphoproliferative disorder).