Kidney transplantation is a preferable treatment of children with end-stage kidney disease. All kidney
transplant recipients, including pediatric need immunosuppressive medications to prevent rejection episodes and
Induction therapy is used temporarily only immediately following transplantation while maintenance immunosuppressive
drugs are started and given long-term. There is currently no consensus regarding the use of induction
therapy in children; its use should be decided based on the immunological risk of the child.
The recent progress shows that the recommended strategy is to use as maintenance immunosuppressive therapy a
combination of a calcineurin inhibitor (preferably tacrolimus) with an antiproliferative drug (preferably mycophenolate
mofetil) with steroids that can be withdrawn early or late in low-risk children. The mTOR-inhibitors
(sirolimus, everolimus) are used rarely in pediatrics because of common side effects and no evidence of a benefit
over calcineurin inhibitors. The use of calcineurin inhibitors, mycophenolate, and mTOR-inhibitors should be
followed by therapeutic drug monitoring.
Immunosuppressive therapy of acute rejection consists of high-dose steroids and/or anti-lymphocyte antibodies
(T-cell mediated rejection) or plasma exchange, intravenous immunoglobulines and/or rituximab (antibodymediated
The future strategies for research are mainly precise characterisation of children needing induction therapy, more
specific indications for mTOR-inhibitors and for the far future, the possibility to reach the immuno tolerance.