Can pediatric steroid-free renal transplantation improve growth and metabolic complications?
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.
Bhakta
Nihar
N
Department of Pediatrics, Division of Pediatric Nephrology, Mattel Children's Hospital at UCLA, 650 Charles Young Drive, A2383 MDCC, Los Angeles, CA 90024, USA. nbhakta@mednet.ucla.edu
Marik
Jennifer
J
Malekzadeh
Mohammad
M
Gjertson
David
D
Ettenger
Robert
R
D000293:Adolescent; D000328:Adult; D000911:Antibodies, Monoclonal / Q000494:pharmacology; D061067:Antibodies, Monoclonal, Humanized; D002648:Child; D002675:Child, Preschool; D002712:Chlorides / Q000378:metabolism; D002784:Cholesterol / Q000378:metabolism; D017608:Chromium Compounds / Q000378:metabolism; D000077561:Daclizumab; D005260:Female; D006085:Graft Survival; D006801:Humans; D007074:Immunoglobulin G / Q000494:pharmacology; D007166:Immunosuppressive Agents / Q000494:pharmacology; D007223:Infant; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000494:pharmacology; D010372:Pediatrics / Q000379:methods; D013256:Steroids / Q000378:metabolism*; D016559:Tacrolimus / Q000494:pharmacology; D016896:Treatment Outcome
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D002712:Chlorides; D017608:Chromium Compounds; D007074:Immunoglobulin G; D007166:Immunosuppressive Agents; D013256:Steroids; D002784:Cholesterol; C017133:chromous chloride; D000077561:Daclizumab; D009173:Mycophenolic Acid; D016559:Tacrolimus