Steroid minimization in pediatric renal transplantation: Early withdrawal or avoidance?
Clinically important adverse events associated with the use of corticosteroids post-transplantation include hypertension, dyslipidemia, impaired glucose metabolism (including diabetes mellitus), growth retardation, bone fractures, and cosmetic problems. Over recent years, a number of studies have investigated the effect of minimizing exposure to corticosteroids in post-transplant immunosuppression protocols in both adults and children. In pediatric patients, several different approaches have been evaluated, including late steroid withdrawal, early steroid withdrawal, and complete steroid avoidance with or without poly- or monoclonal antibody induction and a variety of maintenance immunosuppressants. This manuscript reviews the key studies and documents the specific clinical benefits associated with steroid minimization. The development of PTLD and bone marrow suppression has been a major safety concern in some of these studies. These studies and other adverse effects are discussed.
Grenda
Ryszard
R
Department of Nephrology, Kidney Transplantation and Hypertension, The Children's Memorial Health Institute, Warsaw, Poland. r.grenda@czd.pl
Webb
Nicholas J A
NJ
D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D002648:Child; D002986:Clinical Trials as Topic; D006084:Graft Rejection / Q000188:drug therapy / Q000276:immunology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000276:immunology*; D012307:Risk Factors; D014766:Viremia / Q000517:prevention & control
D000305:Adrenal Cortex Hormones; D000911:Antibodies, Monoclonal; D007166:Immunosuppressive Agents