TY - JOUR
T1 - Early steroid withdrawal in pediatric renal transplant
T2 - Five years of follow-up
AU - Delucchi, Ángela
AU - Valenzuela, Marcela
AU - Lillo, Ana M.
AU - Guerrero, Jose Luis
AU - Cano, Francisco
AU - Azocar, Marta
AU - Zambrano, Pedro
AU - Salas, Paulina
AU - Pinto, Viola
AU - Ferrario, Mario
AU - Rodríguez, Jorge
AU - Cavada, Gabriel
N1 - Funding Information:
This study was supported by a financial grant from Fondo Nacional de Desarrollo Científico y Tecnológico; FONDECYT 1080166.
PY - 2011/12
Y1 - 2011/12
N2 - This prospective, comparative trial investigated the impact on mean change in height standard deviation score (SDS), acute rejection rate, and renal function of early steroid withdrawal in 96 recipients with 5 years of follow-up. Recipients under basiliximab induction and steroid withdrawal (SW: TAC/MMF; n=55) were compared with a matched steroid control group (SC: TAC/MMF/STEROID, n=41). SW received steroids until Day 6, SC decreased to 10 mg/m 2 within 2 months post-transplant. Five years after SW, the longitudinal growth (SDS) gain was 1.4±0.4 vs. 1.1±0.3 for SC group (p<0.02). Height benefits in prepubertal and pubertal status in both groups were demonstrated in the delta growth trends (mixed model; p<0.01). Biopsy-proven acute rejection in SW was 11% and 17.5%, SC (p: ns). Mean eGFR (ml/min/1.73 m 2) at 5 years post-transplant was SW 80.6±27.8 vs. 82.6±25.1 for SC (p: ns). The death-censored graft survival rate at 1 and 5 years was 99 and 90% for SW; 98 and 96% for SC (p = ns). PTLD incidence in SW 3.3 vs. 2.5% in SC (p: ns). Five years post-transplant, early steroid withdrawal showed positive impacts on growth, stable renal function without increased acute rejection risk, and PTLD incidence.
AB - This prospective, comparative trial investigated the impact on mean change in height standard deviation score (SDS), acute rejection rate, and renal function of early steroid withdrawal in 96 recipients with 5 years of follow-up. Recipients under basiliximab induction and steroid withdrawal (SW: TAC/MMF; n=55) were compared with a matched steroid control group (SC: TAC/MMF/STEROID, n=41). SW received steroids until Day 6, SC decreased to 10 mg/m 2 within 2 months post-transplant. Five years after SW, the longitudinal growth (SDS) gain was 1.4±0.4 vs. 1.1±0.3 for SC group (p<0.02). Height benefits in prepubertal and pubertal status in both groups were demonstrated in the delta growth trends (mixed model; p<0.01). Biopsy-proven acute rejection in SW was 11% and 17.5%, SC (p: ns). Mean eGFR (ml/min/1.73 m 2) at 5 years post-transplant was SW 80.6±27.8 vs. 82.6±25.1 for SC (p: ns). The death-censored graft survival rate at 1 and 5 years was 99 and 90% for SW; 98 and 96% for SC (p = ns). PTLD incidence in SW 3.3 vs. 2.5% in SC (p: ns). Five years post-transplant, early steroid withdrawal showed positive impacts on growth, stable renal function without increased acute rejection risk, and PTLD incidence.
KW - Immunosuppressive treatment
KW - Pediatric kidney transplantation
KW - Steroid withdrawal
UR - http://www.scopus.com/inward/record.url?scp=83055181500&partnerID=8YFLogxK
U2 - 10.1007/s00467-011-1934-6
DO - 10.1007/s00467-011-1934-6
M3 - Article
C2 - 21695450
AN - SCOPUS:83055181500
SN - 0931-041X
VL - 26
SP - 2235
EP - 2244
JO - Pediatric Nephrology
JF - Pediatric Nephrology
IS - 12
ER -