A prospective trial of steroid withdrawal after renal transplantation treated with cyclosporine and mizoribine in children: Results obtained between 1990 and 2003

Abstract

A prospective trial of adrenocorticostertoid (steroid) withdrawal after pediatric renal transplantation was begun in 1990. Ninety-four pediatric renal transplant recipients were enrolled in our multicenter study. Immunosuppressive therapy with cyclosporine (CyA), methylprednisolone (MPL), and mizoribine (MZ) was started after transplantation. MPL was reduced to administration on alternate days in 69 patients (73.4%) and was withdrawn in 27 patients (28.7%). Rejection episodes occurred in nine patients (33.3%) after withdrawal of MPL. It occurred within 3 months after withdrawal of MPL in two patients and more than 6 months in the others. Among them, two patients lost the grafts. Thirteen-year patient survival rate and graft survival rate were 94.6 and 83.1%, respectively. Forty-four of the 94 patients reached their final height. Mean final height was 155.0 cm in males and 146.3 cm in females and their height standard deviation score was -2.6 s.d., the same as that at the time of transplantation. Management of growth retardation before transplantation and further reduction in the steroid dose after transplantation will increase the final height of children with chronic renal failure.

Steroid Minimization in Pediatric Renal Transplantation

“…Since the first anecdotal success by Birkeland et al with the use of a steroid free regimen in 14 pediatric patients, many centers, including ours, have reported their successful experience with steroid minimization in pediatric allograft recipients, using various novel protocols in a non-randomized manner [17][18][19][20][21][22][23][24]. These reports not only further support the feasibility and safety of steroid avoidance or minimization but they also affirm the potential metabolic benefits observed in adult patients.…”

Late Consequences of Chronic Pediatric Illness

“…After transplant, some children show improved growth, but height remains suboptimal, and steroids needed to maintain the transplant contribute to obesity [23]. Management of growth retardation before transplantation and further reduction in the steroid dose after transplantation may increase final height of children with chronic renal failure [24].…”

Effects of steroid avoidance and novel protocols on growth in paediatric renal transplant patients

“…Evidence based on a number of late and early withdrawal trials and steroid avoidance trials indicates that a total elimination of steroids is an effective approach for promoting growth improvement. Paediatric studies evaluating growth under the above strategies are summarized in Table 1 [8][9][10][11][12][13][14][15][16][17][18][19].…”