LAUSR

Despite the clinical advancements made in pediatric kidney transplantation, long-term outcomes remain sub-optimal. According to recent data from the North American Pediatric Renal Trial and Collaborative Studies (NAPRTCS), pediatric allograft function and survival continue to decline over time on predominantly calcineurin inhibitor (CNI) based regimens (1). Remarkably, rates of acute rejection (1) and de novo donor specific antibody (dnDSA) development continue to rise, especially in children >12 years of age. Additionally, close to 50% of centers in the United States still employ steroid-based maintenance immunosuppression (1) even with detrimental side effects such as metabolic derangements, poor growth, and ocular complications.