Avoiding steroids in pediatric renal transplantation: Long‐term experience from a single centre

Abstract

We report our experience in pediatric renal transplantation avoiding steroids whenever possible. Immunosuppression consisted of an initial induction with antithymocyte globulin followed by maintenance therapy with a calcineurin inhibitor and MMF. Steroids were only given to selected patients because of the primary disease, recurrence, rejection, or PTLD. Thirty-four transplants grafted into 32 recipients between 1995 and 2005 were followed for a median of 3.5 yr (range 1-9.8). All patients survived. Graft rejection occurred in 10 cases during the first year post-transplantation and graft survival at one, five, and seven yr was 97, 88 and 88%, respectively. Steroids were given to half of the patients (n = 16); in nine cases due to rejection. Only four patients (13%) were continuously on steroids. Calculated GFR at one to five yr post-transplant were 73, 74, 68, 64, and 70 mL/min/1.73 m(2). Unfortunately PTLD occurred in three patients, but all survived with functioning grafts. Accordingly, our findings indicate that steroid avoidance in pediatric renal transplantation is possible with good results with respect to acute graft rejection as well as long-term graft survival.

Effect of childhood kidney transplantation on puberty

“…In this regard, our results are in agreement with Reisman et al (34) in the conclusion that even a small maintenance dose of 0.15-0.20 mg/ kg of daily prednisolone will have undesirable effects on growth. Total avoidance of steroids and early steroid withdrawal in pediatric KTX was shown to be possible with good results regarding acute graft rejection and long-term graft survival (35,36).…”

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

“…All prepubertal patients who regularly attended the Pediatric Renal Transplant section of Hospital Italiano, Buenos Aires, Argentina were considered eligible for our study if they met the following inclusion criteria: (1) had received a kidney from a living-related donor, (2) were prepubertal, (3) had panel reactive antibodies levels <10%, (4) had started a posttransplant immunosuppressive protocol with either cyclosporin microemulsion (CsA) or tacrolimus (Tac), in both cases associated with mycophenolate mofetil (MMF) and glucocorticoids, (5) had a functional allograft beyond the third year after kidney transplantation, (6) had no previous episode of acute or chronic rejection, CsA or Tac toxicity, or renal artery stenosis, (7) had no family history of hyperlipidemia, and (8) had no clinical history of lipid-lowering pharmacological therapy. From a total of 450 patients who underwent consecutive kidney transplantation, 32 fulfilled the criteria for further review of their medical charts/records, and all had been transplanted between 1998 and 2005.…”

“…Thereafter, from month 4 onwards, patients in the MP-STD group were maintained at 0.2 mg/kg/day until the end of the study. Patients in the DFZ group were maintained on MP at 0.2 mg/kg/day for one additional year and then (month 16) switched to DFZ at equivalent doses (0.3 mg/kg/day) [7]. In the MP-LSW group, from month 4 onwards, patients were maintained on MP at <0.1 mg/kg/day for 1 additional year, with the MP finally withdrawn by month 16.…”

“…Recent studies show that early or late withdrawal [2][3][4][5] or complete avoidance [6,7] of glucocorticoids right from the beginning of the transplant is associated with an increase in height growth. In line with these observations, we have previously and prospectively demonstrated that (1) methylprednisone (MP)-late withdrawal (>12 months posttransplant) and MP-very low dose (<0.1 mg/kg/day) have similar increments on height growth [8] and (2) deflazacort (DFZ, an oxazoline analog of prednisone) is associated with a lower incidence of side effects than immunosuppressive regimens based upon MP at standard doses (0.2 mg/kg/day) [9].…”

Use of antibody induction in pediatric renal transplantation

“…For example, Pedersen et al [9] reported their results with steroid avoidance using initial induction with anti-thymocyte globulin and maintenance therapy with a CNI and mycophenolate mofetil (MMF). Steroids were only for selected types of primary disease, recurrence, rejection, or lymphoma.…”