Induction immunosuppression practices for pediatric kidney transplant recipients in India
Anshuman Saha1, Nivedita Kamath2, Sarbpreet Singh3, Aditi Sinha4, Siddini Vishwanath5, Umapathi Hegde6, Indira Agrawal7, Kinnari Vala1, Arpana Iyengar2, Rajiv Sinha8, Mehul Shah9, Manoj Matnani10, Sukanya Govindan11, Saumil Gaur12, Ashish Sharma3, Pankaj Hari4, Kishore Babu S5, Vivek Kute1.
1Pediatric Nephrology, Institute of Kidney Diseases and Research Centre, Ahmedabad Gujarat, India; 2Pediatric Nephrology, St John's Medical College , Bengaluru, India; 3Transplantation Surgery, PGIMER, Chandigarh, India; 4Pediatric Nephrology, AIIMS, New Delhi, India; 5Nephrology, Manipal Hospitals, Bengaluru, India; 6Nephrology, Mulji Bhai Patel Urological Hospital, Nadiad, India; 7Pediatric Nephrology, Christian Medical College, Vellore, India; 8Pediatric Nephrology, Institute of child health, Kolkata, India; 9Pediatric Nephrology, Apollo Hospitals, Hyderabad, India; 10Pediatric Nephrology, Jehangir Hospital, Pune, India; 11Pediatric Nephrology, Mehta's children hospital, Chennai, India; 12Pediatrics, Rainbow children hospital, Bengaluru, India
Background: Very limited information exists regarding the induction immunosuppression practices in pediatric kidney transplant recipients among transplant physicians in India. The aim of the online survey was to understand the practice pattern
Methods: A google form with questionnaire was send to transplant physicians and surgeons taking care of pediatric kidney transplant recipients across India. The questionnaire had part A which asked about the choice of induction agents in various immunological risk patients. Part B asked about the quantitative data of total number of patients receiving different induction agents, the 1-year patient and graft survival and acute rejection rate in the respective centres.
Results: The survey was sent via email to 20 centres who are doing pediatric kidney transplantation in India out of which 12 centres responded to the survey. Basiliximab was the overall most common induction agent used (7 centres, 58.3%). In low immunological risk living donor transplant, Basiliximab was used by majority centres (7, 58.3%). rATG was the induction agent of choice for deceased donor transplants in majority centres (5 out of 6, 83.3%). Four centres which did high immunological risk transplants two used rATG, 1 rATG/Grfalon with rituximab. When ATG was used as induction in low immunological risk children, majority used total dose 3 mg/kg. Higher dose of 3-4.5 mg/kg total dose was used by 50% of centres in deceased donor transplants. The dose of methylprednisolone varied between 10-30 mg/kg from 1-3 days. All the centres used tacrolimus, Mycophenolate and prednisolone based triple immunosuppression. Total 369 children underwent kidney transplantation in last 5 years in 12 responding centres. Among low risk living donor kidney transplant recipients, majority, 122 (43.4%) received Basiliximab, 98 (34.8%) received ATG and 61(21.7%) didnot receive any induction immunosuppression. In contrast 73 (95%) deceased donor recipients received rATG. Eleven ABO incompatible kidney transplant recipient received Basiliximab, one received ATG. All HLA sensitized recipient received ATG as induction agent. Fiftyfive recipients (14.9%) had acute rejection in 1-year post-transplant period. Average 1-year patient survival was 97.8% and average 1-year graft survival was 94.4%. Total 31 children (8.4%) developed CMV viremia, 13 (3.5%) BKV infection and 5 (1.3%) developed EBV infection.
Conclusion: The study gives an overview of induction immunosuppression practices in pediatric kidney transplantation in India and highlights the heterogeneity of the practices
[1] Iinduction immunosuppression
[2] Kidney transplant
[3] children