A study on strategies for improving growth and body composition after renal transplantation

Abstract

Allograft function and metabolic effects of four treatment regimens, namely, methylprednisone (MP) standard dose (MP-STD), deflazacort (DFZ), MP-late steroid withdrawal (MP-LSW), and MP-very low dose (MP-VLD), were evaluated in prepubertal patients. MP was decreased by month 4 post-transplantation to 0.2 mg/kg/day in MP-STD and DFZ patients and to <0.1 mg/kg/day in MP-LSW and MP-VLD patients. Starting in month 16 post-transplant, MP was switched to DFZ in the DFZ group and totally withdrawn in the MP-LSW group. Creatinine clearance diminished in the MP-STD and MP-LSW groups from 77 +/- 6 to 63 +/- 6 ml/min/1.73 m(2)and from 103 +/- 5 to 78 +/- 3 ml/min/1.73 m(2), respectively (p < 0.01 and p < 0.001, respectively). Height increased >0.5 SDS only in the MP-LSW and MP-VLD groups. The body mass index and fat body mass for height-age increased only in the MP-STD patients (p < 0.05 and p < 0.01, respectively). Fat body mass decreased in the DFZ group (p < 0.05), total cholesterol and LDL-cholesterol increased in the MP-STD group, while LDL-cholesterol and total cholesterol/HDL-cholesterol ratio decreased in the DFZ group (p < 0.01). Lumbar spine bone mineral density (BMD) for height-age showed an increase in the MP-LSW and MP-VLD groups (p < 0.01). Our data suggest that MP-LSW and MP-VLD strategies improve linear growth, BMD, the peripheral distribution of fat, and preservation of the bone-muscle unit and maintain the normal lipid profile. The MP-LSW patients had a concerning rate of acute rejections and graft function deterioration in prepubertal patients.

Growth of kidney-transplanted pediatric patients treated with sirolimus

“…As shown in previous studies, the SRL Table 2 Clinical characteristics and growth data in two groups of prepubertal renal transplanted children, SRL and control, having good renal function and on low daily prednisone dose. Except for gender and primary renal disease, the results are expressed as mean ± SD association of those three conditions facilitates the occurrence of catch-up growth in pediatric kidney transplant on immunosuppressive treatment with CNIs and mycophenolate [20][21][22][23][24][25][26][27]. In agreement with this assumption, our control group of patients with a mean age at the study entry of 4.7 years, mean corticosteroid dose during follow-up of approximately 2 mg/day and normal GFR exhibited a positive change in the height Z score whereas this effect was not found in the subgroup of SRL-treated patients with similar age, prednisone dose and renal function ( It is of note that preliminary experimental data [28] and a single case report [15] indicate that treatment with recombinant human growth hormone (rhGH) may reverse, at least partially, the negative effect on longitudinal growth caused by SRL.…”

Dyslipidaemia in children on renal replacement therapy

“…The use of tacrolimus instead of cyclosporin has been associated with better graft function in paediatric [42] and adult renal graft recipients [43,44]. A significantly improved lipid profile was found after late steroid withdrawal [45], and with reducing the use of steroids to very low doses [46]. One of the most notable side effects of sirolimus use is a marked increase in serum lipid levels [47].…”

Corticosteroid Use and Growth After Pediatric Solid Organ Transplantation

“…Eight studies (n = 5 RCTs 20,21,23,24,26 ; n = 3 observational 25,27,28 ]; n = 339 patients) reported growth data in prepubertal children, defined either by Tanner stage or aged younger than 5 years. Five studies reported change in height SDS over 12 months (n = 4) or 6 months (n = 1), whereas 3 studies reported the 12-month final height SDS.…”

“…Test for subgroup difference demonstrated was significantly different (χ 2 = 5.94; P = 0.01; I 2 = 83.2%). Pooled data for the 2 observational studies 25,28 that provided 12-month final height showed that corticosteroid withdrawal/avoidance was associated with a significant improvement in height (SDS, 1.07; 95% CI, 0.11-2.04; P = 0.03; I 2 = 0; χ 2 = 0.01; P = 0.92). Final height for pubertal patients was only provided in the study by Hocker et al precluding any meta-analysis.…”