Inmunosupresores y principales complicaciones en el trasplante renal pediátrico

  • Gustavo Adolfo Guerrero-Tinoco Hospital Infantil Napoleón Franco Pareja de la ciudad de Cartagena de Indias, Colombia
  • Douglas Ramón Villafañe-Bermúdez Hospital Infantil Napoleón Franco Pareja de la ciudad de Cartagena de Indias, Colombia
  • Catalina Vélez Echeverri Universidad de Antioquia, Hospital Pablo Tobón Uribe, Medellín, Colombia.
Palabras clave: Inmunosupresores, Pediátrico, Rechazo, Trasplante Renal

Resumen

El trasplante renal pediátrico es el tratamiento de elección en los niños con enfermedad renal crónica terminal. Muchos agentes se utilizan en dos regímenes de terapia inmunosupresora, primero en una fase de inducción y posteriormente para el mantenimiento. Existen dos estrategias para disminuir el riesgo de rechazo del injerto renal: la primera consiste en suministrar altas dosis de los inmunosupresores convencionales, y la segunda, en la utilización en la fase de inducción de anticuerpos monoclonales o policlonales contra antígenos de los linfocitos T. Los dos anticuerpos policlonales más usados son las globulinas antitimocito de caballo (ATGAM) y de conejo (rATG). Los anticuerpos monoclonales más usados son aquellos contra el receptor de IL-2 (basiliximab y daclizumab) y el dirigido contra el antígeno CD52 (alemtuzumab). La terapia de mantenimiento consiste en un esquema que combina el uso de tres drogas inmunosupresoras convencionales: glucocorticoides, inhibidores de la calcineurina, inhibidores de mTOR y antiproliferativos. Entre las principales complicaciones del trasplante renal pediátrico están: rechazo agudo del injerto, infecciones virales (por poliomavirus-BK y citomegalovirus) y aparición del trastorno linfoproliferativo postrasplante (PTLD, por la sigla en inglés de Post-transplant lymphoproliferative disorder). 

Biografía del autor/a

Gustavo Adolfo Guerrero-Tinoco, Hospital Infantil Napoleón Franco Pareja de la ciudad de Cartagena de Indias, Colombia
Nefrólogo pediatra. 
Douglas Ramón Villafañe-Bermúdez, Hospital Infantil Napoleón Franco Pareja de la ciudad de Cartagena de Indias, Colombia
Nefrólogo pediatra. 
Catalina Vélez Echeverri, Universidad de Antioquia, Hospital Pablo Tobón Uribe, Medellín, Colombia.
Nefróloga pediatra. Docente.

Citas

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Publicado
2016-12-23
Sección
Artículos de revisión