NICE has made the following recommendations about the use of immunosuppressive drugs in children and adolescents receiving kidney transplants:
Basiliximab and daclizumab
Doctors should consider using basiliximab or daclizumab for induction therapy. These drugs should only be used with a combination of other drugs that includes ciclosporin.
Tacrolimus is a calcineurin inhibitor and can be used instead of ciclosporin when a person needs a calcineurin inhibitor as part of their initial therapy or maintenance therapy.
Doctors should consider using mycophenolate mofetil as part of immunosuppressive treatment after kidney transplantation only when a person has to stop taking a calcineurin inhibitor, or has to take a lower dose.
NICE does not recommend the use of mycophenolate sodium as part of immunosuppressive regimens for children or adolescents undergoing kidney transplantation.
NICE does not recommend the use of sirolimus as part of immunosuppressive regimens for children or adolescents undergoing kidney transplantation, except when a patient has had to stop taking calcineurin inhibitors because of their side effects.
The recommendations in this guidance represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take this guidance fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this guidance is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Commissioners and/or providers have a responsibility to provide the funding required to enable the guidance to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.