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This is a retrospective registry analysis of the long-term medication modifications in the Nordic countries.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>All pediatric KT recipients transplanted between the years 2005 and 2016 were identified from the Scandiatransplant registry. Of the 482 patients, 345 met the inclusion criteria: age below 16\u00a0years at KT and at least 2\u00a0years post-transplant follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A change in maintenance immunosuppression occurred in 160 patients (46.4%) at 2.0 (interquartile range 1.0\u20133.0) years median time from KT. The most common change (35.8%) was switching cyclosporine A (CsA) to tacrolimus (Tac). Initial CsA treatment was modified significantly more often compared to Tac (72.0% vs. 6.0%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Modifications of mycophenolate mofetil (MMF) were observed more often in recipients aged\u2009&lt;\u20092 (75.0%) and 2\u20135 (55.6%) years compared with 5\u201316\u00a0years (13.2%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001); particularly, MMF discontinuation was common (&lt;\u20092\u00a0years 45.8% and 2\u20135\u00a0years 38.9%). Otherwise, initial immunosuppression remained mainly unchanged. The main reasons for changing CsA to Tac were cosmetic side effects (26.2%), rejections (26.2%), and declining graft function (23.0%). In case of rejection or declining graft function\n                      <jats:bold>,<\/jats:bold>\n                      CsA-to-Tac conversion slowed the decrease in measured glomerular filtration rate. MMF modifications did not affect graft survival from 2 to 7.5\u00a0years post-transplant.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Maintenance immunosuppression is modified in almost half of pediatric KT recipients. Particularly, CsA conversion to Tac and young recipients\u2019 MMF modifications are common.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Graphical abstract<\/jats:title>\n                  <\/jats:sec>","DOI":"10.1007\/s00467-025-07030-7","type":"journal-article","created":{"date-parts":[[2025,11,13]],"date-time":"2025-11-13T00:33:47Z","timestamp":1762994027000},"page":"547-556","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Changes in maintenance immunosuppression after pediatric kidney transplantation\u2014a report from the Nordic pediatric kidney transplantation registry"],"prefix":"10.1007","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8887-1123","authenticated-orcid":false,"given":"Henna","family":"Kaijansinkko","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0415-7403","authenticated-orcid":false,"given":"Juuso","family":"Tainio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1421-0098","authenticated-orcid":false,"given":"Anna","family":"Bjerre","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4678-458X","authenticated-orcid":false,"given":"Ann Christin","family":"Gjerstad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-3571-1168","authenticated-orcid":false,"given":"Ilse D. 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Am J Transplant 4:222\u2013230. https:\/\/doi.org\/10.1046\/j.1600-6143.2003.00325.x","journal-title":"Am J Transplant"}],"container-title":["Pediatric Nephrology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00467-025-07030-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00467-025-07030-7","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00467-025-07030-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T21:02:40Z","timestamp":1766523760000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00467-025-07030-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,13]]},"references-count":32,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,2]]}},"alternative-id":["7030"],"URL":"https:\/\/doi.org\/10.1007\/s00467-025-07030-7","relation":{},"ISSN":["0931-041X","1432-198X"],"issn-type":[{"value":"0931-041X","type":"print"},{"value":"1432-198X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,13]]},"assertion":[{"value":"31 May 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 October 2025","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 October 2025","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 November 2025","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This registry study was conducted retrospectively. The Research Ethics Committee of Helsinki and Uusimaa Hospital District approved the study (HUS 939\/2018).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}