title: 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.
authors.affiliation: Department of Nephrology Y, Odense University Hospital, Odense C, Denmark. erik.bo.pedersen@ouh.fyns-amt.dk
authors.forename: Erik Bo
authors.initials: EB
authors.lastname: Pedersen
authors.forename: Mohamad
authors.initials: M
authors.lastname: El-Faramawi
authors.forename: Nils
authors.initials: N
authors.lastname: Foged
authors.forename: Karl-Egon
authors.initials: KE
authors.lastname: Larsen
authors.forename: Bente
authors.initials: B
authors.lastname: Jespersen
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000009:adverse effects*; D000959:Antihypertensive Agents / Q000627:therapeutic use; D000961:Antilymphocyte Serum / Q000627:therapeutic use; D002648:Child; D003587:Cytomegalovirus / Q000302:isolation & purification; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000188:drug therapy; D006085:Graft Survival; D006128:Growth / Q000502:physiology; D004854:Herpesvirus 4, Human / Q000302:isolation & purification; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016030:Kidney Transplantation / Q000276:immunology / Q000502:physiology*; D011183:Postoperative Complications / Q000517:prevention & control; D013927:Thrombosis / Q000517:prevention & control; D013997:Time Factors
chemical_list: D000305:Adrenal Cortex Hormones; D000959:Antihypertensive Agents; D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents