Induction and maintenance immunosuppression in pediatric kidney transplantation—Advances and controversies

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Advances in immunosuppression have improved graft survival in pediatric kidney transplant recipients; however, treatment-related toxicities need to be balanced against the possibility of graft rejection. Several immunosuppressive agents are available for use in transplant recipients; however, the optimal combinations of agents remain unclear, resulting in variations in institutional protocols. Lymphocyte-depleting antibodies, specifically ATG, are the most common induction agent used for pediatric kidney transplantation in the US. Basiliximab may be used for induction in immunologically low-risk children; however, pediatric data are scarce. CNIs and antiproliferative agents (mostly Tac and mycophenolate in recent years) constitute the backbone of maintenance immunosuppression. Steroid-avoidance maintenance regimens remain controversial. Belatacept and mTOR inhibitors are used in children under specific circumstances such as non-adherence or CNI toxicity. This article reviews the indications, mechanism of action, efficacy, dosing, and side effect profiles of various immunosuppressive agents available for pediatric kidney transplantation.

Original languageEnglish (US)
Article numbere14077
JournalPediatric transplantation
Issue number7
Early online dateJul 3 2021
StatePublished - Nov 2021

Bibliographical note

Publisher Copyright:
© 2021 Wiley Periodicals LLC


  • immunosuppressive treatment
  • pediatric kidney transplantation

PubMed: MeSH publication types

  • Journal Article
  • Review


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