Out with the old, in with the new: immunosuppression minimization in children

Abstract

To cover the current literature on immunosuppression minimization strategies in pediatric transplantation, with an emphasis on an application of these strategies in renal transplantation. Safe elimination of certain immunosuppressives carry unprecedented advantages for reducing patient morbidity and chronic graft injury, but may also result in unanticipated changes in immunological homeostasis and drug pharmacokinetics. Closer surveillance for posttransplant infections and alterations in drug bioavailability and dosing as well as break-through immunologic responses are required. Immunosuppression minimization strategies, under the umbrella of a newer generation of more powerful induction and maintenance immunosuppressants, are being increasingly applied to pediatric organ transplantation, with the greatest emphasis on minimization of steroids and calcineurin inhibitor agents. The success of some of these protocols may support their immediate application to clinical practice.