title: Steroid avoidance using sirolimus and cyclosporine in pediatric renal transplantation: one year analysis.
abstract: Steroids are commonly used in pediatric renal transplantation, but have numerous adverse effects. This retrospective study compares one-yr outcomes in 22 pediatric renal transplant recipients receiving SRL and CSA as primary immunosuppression (steroid-avoidance group) to age- and gender-matched historical controls receiving CSA, MMF, and prednisone (steroid group). At one yr, both groups had similar graft survival, acute rejection, and estimated GFR. Subjects in the steroid-avoidance group had better linear growth, less excessive weight gain and were less likely to have an increase in antihypertensive medication use. Subjects in the steroid-avoidance group were more likely to be started on lipid lowering medications and erythropoiesis stimulating agents. Despite having a greater proportion of living donors, the steroid-avoidance group had a similar GFR compared to the steroid group at one month. The steroid-avoidance group was also more likely to have a biopsy for elevated Cr that was not because of rejection and had more interstitial fibrosis noted. We conclude that using a steroid-avoidance immunosuppression regimen of SRL and CSA results in comparable rejection rates and short-term graft function with less steroid-associated morbidity. However, early findings also suggest possible potentiation of CSA nephrotoxicity by SRL in some children.
authors.affiliation: Department of Pediatrics, Section of Nephrology, Nationwide Children's Hospital, Columbus, OH 43205, USA.
authors.forename: Franca M
authors.initials: FM
authors.lastname: Iorember
authors.forename: Hiren P
authors.initials: HP
authors.lastname: Patel
authors.forename: Alison
authors.initials: A
authors.lastname: Ohana
authors.forename: John R
authors.initials: JR
authors.lastname: Hayes
authors.forename: John D
authors.initials: JD
authors.lastname: Mahan
authors.forename: Peter B
authors.initials: PB
authors.lastname: Baker
authors.forename: Amer
authors.initials: A
authors.lastname: Rajab
mesh_terms: D000293:Adolescent; D001706:Biopsy; D000075202:Contraindications; D016572:Cyclosporine / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids; D006084:Graft Rejection / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology; D006085:Graft Survival / Q000187:drug effects*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016030:Kidney Transplantation; D008297:Male; D009017:Morbidity / Q000639:trends; D011241:Prednisone; D012189:Retrospective Studies; D020123:Sirolimus / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
chemical_list: D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D011241:Prednisone; D020123:Sirolimus