A study on strategies for improving growth and body composition after renal transplantation.
Allograft function and metabolic effects of four treatment regimens, namely, methylprednisone (MP) standard dose (MP-STD), deflazacort (DFZ), MP-late steroid withdrawal (MP-LSW), and MP-very low dose (MP-VLD), were evaluated in prepubertal patients. MP was decreased by month 4 post-transplantation to 0.2 mg/kg/day in MP-STD and DFZ patients and to <0.1 mg/kg/day in MP-LSW and MP-VLD patients. Starting in month 16 post-transplant, MP was switched to DFZ in the DFZ group and totally withdrawn in the MP-LSW group. Creatinine clearance diminished in the MP-STD and MP-LSW groups from 77 +/- 6 to 63 +/- 6 ml/min/1.73 m(2)and from 103 +/- 5 to 78 +/- 3 ml/min/1.73 m(2), respectively (p < 0.01 and p < 0.001, respectively). Height increased >0.5 SDS only in the MP-LSW and MP-VLD groups. The body mass index and fat body mass for height-age increased only in the MP-STD patients (p < 0.05 and p < 0.01, respectively). Fat body mass decreased in the DFZ group (p < 0.05), total cholesterol and LDL-cholesterol increased in the MP-STD group, while LDL-cholesterol and total cholesterol/HDL-cholesterol ratio decreased in the DFZ group (p < 0.01). Lumbar spine bone mineral density (BMD) for height-age showed an increase in the MP-LSW and MP-VLD groups (p < 0.01). Our data suggest that MP-LSW and MP-VLD strategies improve linear growth, BMD, the peripheral distribution of fat, and preservation of the bone-muscle unit and maintain the normal lipid profile. The MP-LSW patients had a concerning rate of acute rejections and graft function deterioration in prepubertal patients.
Servicio de Nefrología Pediátrica, Hospital Italiano, Buenos Aires, Argentina. jorge.ferraris@hospitalitaliano.org.ar
Jorge R
JR
Ferraris
Titania
T
Pasqualini
Guillermo
G
Alonso
Susana
S
Legal
Patricia
P
Sorroche
Ana
A
Galich
Paula
P
Coccia
Lidia
L
Ghezzi
Verónica
V
Ferraris
Liliana
L
Karabatas
Clara
C
Guida
Héctor
H
Jasper
D001823:Body Composition / Q000502:physiology*; D015519:Bone Density / Q000187:drug effects / Q000502:physiology; D002648:Child; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D006084:Graft Rejection / Q000139:chemically induced; D006128:Growth / Q000502:physiology*; D006130:Growth Disorders / Q000503:physiopathology / Q000517:prevention & control* / Q000534:rehabilitation; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000534:rehabilitation; D008159:Lumbar Vertebrae / Q000187:drug effects / Q000378:metabolism; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D011183:Postoperative Complications / Q000517:prevention & control / Q000534:rehabilitation; D011282:Pregnenediones / Q000627:therapeutic use
D007166:Immunosuppressive Agents; D011282:Pregnenediones; C021988:deflazacort; D008775:Methylprednisolone