RESUMO
Prevalence and implications of anti-HLA class I and class II antibodies are beginning to be better characterized in pediatric kidney transplant recipients. dnDSA formation is predictive of AMR and downstream diminished graft function and survival. However, risk factors for the development of dnDSA are not well defined in this patient population. After introducing DSA surveillance into our pediatric kidney transplant program, we are reporting the prevalence of class I and class II DSA in 67 otherwise stable recipients. Secondary end-points included risk factors for DSA development and assessment of graft function. Significantly, lower median daily MMF doses were observed in patients with DSAs compared to patients without DSAs (371 vs 617 mg/m2 /d, respectively; P = 0.035). Class II DSA formation was more common, with a prevalence of 17.9%, as compared to 10.4% for class I DSA. Estimated glomerular filtration rate was also decreased in patients with positive DSA vs those with negative titers (71, SD 25 vs 78, SD 29 mL/min/1.73 m2 , respectively; P = 0.034). We conclude that reduced-dose MMF is associated with dnDSA and DSA is associated with diminished graft function in stable pediatric kidney transplant recipients.
Assuntos
Anticorpos/imunologia , Antígenos HLA/imunologia , Transplante de Rim , Insuficiência Renal/cirurgia , Doadores de Tecidos , Adolescente , Criança , Pré-Escolar , Estudos Transversais , Registros Eletrônicos de Saúde , Feminino , Taxa de Filtração Glomerular , Rejeição de Enxerto/imunologia , Sobrevivência de Enxerto , Transplante de Células-Tronco Hematopoéticas , Teste de Histocompatibilidade , Humanos , Lactente , Masculino , Ácido Micofenólico/farmacologia , Prevalência , Insuficiência Renal/epidemiologia , Insuficiência Renal/imunologia , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: Posaconazole is a broad-spectrum antifungal used for prophylaxis and treatment of invasive fungal infections. There is no published data to inform prescribers on dosing of the intravenous (IV) formulation in the pediatric population. We describe our experience including dosing, serum concentrations, and tolerability. OBSERVATIONS: Four patients (3 to 9 y) received IV posaconazole for treatment of documented/suspected invasive fungal infections. Patients achieved therapeutic concentrations on daily doses of 8.4 to 12.2 mg/kg and adverse effects were minimal. CONCLUSIONS: Higher dosing per body weight of IV posaconazole may be required in the pediatric population compared with adults to consistently achieve therapeutic concentrations.