Can pediatric steroid‐free renal transplantation improve growth and metabolic complications?

Abstract

We analyzed the effects of a steroid avoidance protocol in pediatric renal transplant recipients on calculated CrCl (Schwartz), CMV infection, cholesterol, height Z scores, weight Z scores, and BMI Z scores in a case control trial with contemporaneous controls. From 1999 to 2004, 19 pediatric patients (age 1-20 yr) received transplants without steroids using immunosuppression with tacrolimus, mycophenolate mofetil, and daclizumab. Control patients (n = 30) were matched for length of follow-up (minimum one yr), donor type age, type of immunosuppression, sex, date of transplant, and original disease, and CMV status. Graft survival at one year was 100% in both groups. Mean CrCl of steroid-free vs. control patients were not different at 1 year post-transplant. CMV disease was more prevalent in steroid-treated control group (seven of 30 patients) vs. the steroid free control group (zero of 19). Height delta Z scores at one year were NOT different between groups. Weight and BMI delta Z scores were significantly higher in the control group. Cholesterol levels at one year post-transplant were different in the two groups but NOT ABNORMALLY elevated in either group. At one yr post-transplant, steroid-free immunosuppression with tacrolimus, mycophenolate mofetil and daclizumab provides outcomes that are equivalent or superior to those in contemporaneous control patients receiving steroids.

Complete Steroid Avoidance Is Effective and Safe in Children With Renal Transplants: A Multicenter Randomized Trial With Three-Year Follow-Up

“…Other single-center studies confirmed these findings (26). However, the studies were not prospective and included few African-American recipients, a traditionally high risk group.…”

A Randomized Trial to Assess the Impact of Early Steroid Withdrawal on Growth in Pediatric Renal Transplantation: The TWIST Study

“…These tacrolimus exposure levels were established in a previous study (10 (27). (5,8,16,29) and 0 to 21% with early steroid withdrawal regimens (9,30,31 …”

Outcomes of Steroid-Avoidance Protocols in Pediatric Kidney Transplant Recipients

“…Several trials of complete steroid avoidance (5)(6)(7)(8)(9) or early steroid withdrawal (10)(11)(12) in pediatric patients have been published with encouraging results, with graft survival and incidence of acute rejection similar to steroidbased protocols. These studies, however, have been mostly limited to single center experiences.…”