Renal transplant therapy in children clarified
The National Institute for Health and Clinical Excellence has issued guidance
on immunosuppressive therapy following renal transplantation in children and adolescents.
The guidance states that basiliximab or daclizumab, used as part of a
ciclosporin-based immunosuppressive regimen, is recommended for induction
therapy in the prophylaxis of acute organ rejection in children and adolescents
undergoing renal transplantation.
NICE recommends that tacrolimus is used as an alternative to ciclosporin
when a calcineurin inhibitor is indicated as part of an initial or maintenance
immunosuppressive regimen.
Mycophenolate mofetil can be used when there is proven intolerance to
calcineurin inhibitors, particularly nephrotoxicity which could lead
to risk of chronic allograft dysfunction, or when there is a high risk
of nephrotoxicity necessitating the minimisation or avoidance of calcineurin
inhibitors. It should not be used in corticosteroid reduction or withdrawal
strategies, the guidance adds.
Mycophenolate sodium is not currently recommended as part of immunosuppressive
therapy in child and adolescent transplant recipients. Sirolimus is only
recommended when proven intolerance to calcineurin inhibitors necessitates
complete withdrawal of these treatments.
NICE explains that following this guidance may result in some medicines
being prescribed outside their UK marketing authorisation, and that patients
and their guardians should be made aware of this.
The guidance can be accessed at www.nice.org.uk |
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