title: Selective late steroid withdrawal after renal transplantation.
abstract: Steroid withdrawal (SW) after paediatric renal transplantation (RTPL) is controversial. Selective late SW has been performed in our unit since 1995. The safety and effects of SW were analysed retrospectively in 47 patients undergoing RTPL between 1995 and 2004. Initial immunosuppression consisted of cyclosporine A, azathioprine or mycophenolate mofetil and steroids. Criteria for SW were: (1) stable renal function, (2) time interval after RTPL > or = 1 year, (3) no rejection or time interval after last rejection > or = 1 year and (4) good compliance. SW was performed in 30 patients at an age of 13.5 years (range 4.5-18.5) and 2.2 years (range 1-6.6) after RTPL. After SW, one patient experienced a steroid-sensitive rejection. Follow-up after SW (1.3 year; range 0.25-7.5) showed maintained renal function: glomerular filtration rate at SW and currently was 82 (65-128) and 82 (42-115) ml/min per 1.73 m(2), respectively. The number of patients on antihypertensive treatment did not significantly change (at SW: n = 15; currently: n = 11). Height and body mass index (BMI) remained stable: Median standard deviation score (SDS) for height/BMI at SW and currently was -1.1/0.2 and -0.8/0.1, respectively. Selective late SW was safe regarding renal function and had no significant effect on blood pressure and growth.
authors.affiliation: Nephrology Unit, University Children's Hospital, Steinwiesstrasse 75, CH-8032, Zurich, Switzerland. guido.laube@kispi.uzh.ch
authors.forename: Guido F
authors.initials: GF
authors.lastname: Laube
authors.forename: Jutta
authors.initials: J
authors.lastname: Falger
authors.forename: Markus J
authors.initials: MJ
authors.lastname: Kemper
authors.forename: Andrea
authors.initials: A
authors.lastname: Zingg-Schenk
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Neuhaus
mesh_terms: D000293:Adolescent; D041923:Adolescent Development; D001379:Azathioprine / Q000008:administration & dosage; D001794:Blood Pressure; D002648:Child; D002657:Child Development; D002675:Child, Preschool; D016572:Cyclosporine / Q000008:administration & dosage; D004359:Drug Therapy, Combination; D005260:Female; D006084:Graft Rejection / Q000188:drug therapy*; D006085:Graft Survival / Q000187:drug effects*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D007668:Kidney / Q000502:physiology; D016030:Kidney Transplantation; D008297:Male; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives; D011183:Postoperative Complications; D012189:Retrospective Studies; D013256:Steroids / Q000008:administration & dosage*
chemical_list: D007166:Immunosuppressive Agents; D013256:Steroids; D016572:Cyclosporine; D009173:Mycophenolic Acid; D001379:Azathioprine