title: Minimizing steroid use in pediatric kidney recipients.
abstract: Outcomes of pediatric kidney transplantation have improved significantly over the years, such that the majority of graft recipients survive to become adolescents and adults. In this article, the findings of some of the important trials that shaped the current therapeutic landscape of immunosuppression will be reviewed. As an evolving landscape, novel strategies are continuously being sought to address the significant challenges in pediatric transplantation. Among these challenges is the development of immunosuppressive strategies that not only minimize the risk of allograft rejection but also allow normal growth and developmental patterns in children. To that end, the growing clinical evidence that indicates that the use of steroid-sparing regimens is effective will be reviewed. Finally, a brief description of the TWIST study will be provided. This large-scale comparative study has been designed specifically to assess the effect of early steroid withdrawal on growth in pediatric renal transplant recipients. An overview of the preliminary analysis of the eagerly anticipated results of this landmark trial will also be provided.
authors.affiliation: Department of Nephrology, Kidney Transplantation and Hypertension, Children's Memorial Health Institute, Warsaw, Poland. r.grenda@czd.pl
authors.forename: Ryszard
authors.initials: R
authors.lastname: Grenda
mesh_terms: D058186:Acute Kidney Injury / Q000628:therapy*; D001706:Biopsy; D016572:Cyclosporine / Q000627:therapeutic use; D005919:Glomerular Filtration Rate; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000379:methods*; D015337:Multicenter Studies as Topic; D010372:Pediatrics / Q000379:methods; D016032:Randomized Controlled Trials as Topic; D013256:Steroids / Q000009:adverse effects* / Q000627:therapeutic use*; D016559:Tacrolimus / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D013256:Steroids; D016572:Cyclosporine; D016559:Tacrolimus