Potential influence of tacrolimus and steroid avoidance on early graft function in pediatric renal transplantation

Abstract

With the increasing adoption of steroid-sparing immunosuppression protocols in renal transplantation, it is important to evaluate any adverse effects of steroid avoidance on graft function. Early graft function, measured by CrCl was retrospectively studied in 158 consecutive pediatric renal transplant recipients from 1996 to 2005, receiving either steroid-free or steroid-based immunosuppression. Patients receiving steroid-free immunosuppression vs. steroid-based immunosuppression had no difference change in CrCl (DeltaCrCl) in the first week post-transplantation (p = 0.12). When stratified by corticosteroid usage, patients with higher tacrolimus trough levels (> or =14 ng/mL) had slower graft function recovery in the first week post-transplantation than those with lower tacrolimus trough levels (p = 0.008) in the steroid-free group only. Despite initial slower graft function recovery in this subgroup, there was no negative impact on graft function in the steroid-free group; in fact steroid-free patients trended towards better CrCl at six months (p = 0.047) and 12 months (p < 0.001) post-transplant than the steroid-based group. With the improved immunological outcomes with steroid avoidance, close surveillance should be performed of tacrolimus levels to avoid levels >14 ng/mL. In patients with slow recovery of early graft function, short-term perioperative steroids may be considered.

Steroid Avoidance in Pediatric Heart Transplantation Results in Excellent Graft Survival

“…Other explanations for the worse univariable outcomes in the MS group indude a higher proportion of African Americans, a higher proportion of patients who underwent transplantation in the earlier era, and a higher proportion of patients with a previous sternotomy, all of which have been associated with a higher risk of graft loss (1, 9, 10). The successful use of SF maintenance immunosuppression in our analysis is consistent with single-center and dual-center reports of SF maintenance immunosuppression in heart, liver, and renal transplantation (2, 3, 11, 12). While there are no other studies in pediatric HT directly comparing graft survival in patients with and without MS use, multiple single-center studies of pediatric HT have reported outcomes with an SF maintenance immunosuppression protocol with excellent results (2, 8, 13-16).…”

609 Steroid Avoidance in Pediatric Heart Transplantation Results in Excellent Graft Survival

“…Other explanations for the worse univariable outcomes in the MS group indude a higher proportion of African Americans, a higher proportion of patients who underwent transplantation in the earlier era, and a higher proportion of patients with a previous sternotomy, all of which have been associated with a higher risk of graft loss (1,9,10). The successful use of SF maintenance immunosuppression in our analysis is consistent with single-center and dual-center reports of SF maintenance immunosuppression in heart, liver, and renal transplantation (2,3,11,12). While there are no other studies in pediatric HT directly comparing graft survival in patients with and without MS use, multiple single-center studies of pediatric HT have reported outcomes with an SF maintenance immunosuppression protocol with excellent results (2,8,(13)(14)(15)(16).…”

Dosing equation for tacrolimus using genetic variants and clinical factors

“…Centres were categorized by the use of a steroid sparing immunosuppressive regimen or not. A steroid sparing immunosuppressive protocol administers corticosteroids for a short period of time (typically 7-14 days) in the early posttransplant period whereas non-sparing centres maintain steroids throughout the first 6 months or longer [40,41]. We found that CL/F was decreased by 30% in patients transplanted at a steroid sparing centre.…”