Immunosuppressive Therapy in Pediatric Kidney Transplant Recipients: Current Status and Challenges

相比透析，肾移植是终末期患儿最佳的治疗方式，而免疫抑制治疗则是改善移植受者和移植肾存活率必不可少的手段。但由于儿童在生理、心理、免疫状态、器官功能、原发病等方面与成人存在差异，甚至是不同年龄段的儿童身体状态都存在差异，这就需要在移植术后要有针对性的选择免疫抑制剂及免疫方案。本文从儿童肾移植免疫抑制的现状、当前面临的挑战等方面进行探讨，提高有关个性化用药的思考，以期优化儿童肾移植的免疫抑制管理，以提高儿童移植肾长期存活率、降低慢性排斥反应发生率和避免免疫抑制的并发症。Compared to dialysis, kidney transplantation remains the optimal therapeutic approach for children with end-stage renal disease, while immunosuppressive therapy is indispensable for improving graft and patient survival rates. However, significant differences between children and adults in physiological maturity, psychological development, immune status, organ function, and underlying diseases—as well as distinct physiological characteristics across different pediatric age groups—necessitate personalized selection of immunosuppressive agents and protocols in the post-transplant period. This review examines the current landscape of immunosuppression in pediatric kidney transplantation, highlights persistent challenges in clinical practice, and proposes strategies to refine individualized therapeutic approaches. By optimizing immunosuppressive management, we aim to enhance long-term graft survival, reduce the incidence of chronic rejection, and minimize complications associated with over- or under-immunosuppression in this vulnerable population.