Abstract
Background: In kidney-transplanted children immunosuppressive regimens without tacrolimus are risky and hazardous without an assessment of T-memory cells, because are inhibited only by anticalcineurinic drugs. Combination of low levels of imTOR and tacrolimus without steroids could avoid nephro and neurotoxicity. Also imTOR could promote tolerance through FOX P3 expansion. A combination of advantages would be tried, versus a more classical approach. Patients and methods: Observational study of 62 kidney transplanted children, follow-up of 50±8 months. At the transplant all patients received tacrolimus, sodium mycophenolate and steroids. At the 6th month steroids were withdrawn in all patients. In group I, 42 patients were exposed in this moment to reduced levels of tacrolimus and imTOR (28 everolimus and 14 sirolimus), for a mean blood levels of 4-5 ng/ml for both. In group II, 20 patients were exposed to habitual levels of tacrolimus (8-11 ng/ml) and sodium mycophenolate. Results: – After 1 year Group I showed lower serum creatinine (0,8±0.2 vs. 1.2±0.6 mg/dL) and lower diastolic blood pressure (74±9 vs. 90±11 mm Hg). – No differences in proteinuria were found. In more than 90% of all patients, proteinuria was less than 0,5g/day, and in 70% was negative. – In group II, 4 patients (20%) presented intentional distal tremor in hands, that disappeared when received the regime of Group I, with improvement also of the kidney function. No tremor was registered in Group I. – No acute cellular rejections occurred during the follow-up. Chronic humoral rejection (positive donor-specific antibodies plus biopsy-proved diagnostic) was detected in two patients, one of each group. Conclusion: Combination of low doses of imTOR and tacrolimus, may offer a better renal function and blood pressure and less neurotoxicity without a higher incidence of proteinuria or rejection in kidney-transplanted children.
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