title: Early steroid withdrawal in pediatric renal transplant: five years of follow-up.
abstract: This prospective, comparative trial investigated the impact on mean change in height standard deviation score (SDS), acute rejection rate, and renal function of early steroid withdrawal in 96 recipients with 5 years of follow-up. Recipients under basiliximab induction and steroid withdrawal (SW: TAC/MMF; n = 55) were compared with a matched steroid control group (SC: TAC/MMF/STEROID, n = 41). SW received steroids until Day 6, SC decreased to 10 mg/m(2) within 2 months post-transplant. Five years after SW, the longitudinal growth (SDS) gain was 1.4 ± 0.4 vs. 1.1 ± 0.3 for SC group (p < 0.02). Height benefits in prepubertal and pubertal status in both groups were demonstrated in the delta growth trends (mixed model; p < 0.01). Biopsy-proven acute rejection in SW was 11% and 17.5%, SC (p: ns). Mean eGFR (ml/min/1.73 m(2)) at 5 years post-transplant was SW 80.6 ± 27.8 vs. 82.6 ± 25.1 for SC (p: ns). The death-censored graft survival rate at 1 and 5 years was 99 and 90% for SW; 98 and 96% for SC (p = ns). PTLD incidence in SW 3.3 vs. 2.5% in SC (p: ns). Five years post-transplant, early steroid withdrawal showed positive impacts on growth, stable renal function without increased acute rejection risk, and PTLD incidence.
authors.affiliation: Division of Pediatrics, Luis Calvo Mackenna Children's Hospital, Antonio Varas 360, Santiago, Chile. madelucchi@gmail.com
authors.forename: Angela
authors.initials: A
authors.lastname: Delucchi
authors.forename: Marcela
authors.initials: M
authors.lastname: Valenzuela
authors.forename: Ana M
authors.initials: AM
authors.lastname: Lillo
authors.forename: Jose Luis
authors.initials: JL
authors.lastname: Guerrero
authors.forename: Francisco
authors.initials: F
authors.lastname: Cano
authors.forename: Marta
authors.initials: M
authors.lastname: Azocar
authors.forename: Pedro
authors.initials: P
authors.lastname: Zambrano
authors.forename: Paulina
authors.initials: P
authors.lastname: Salas
authors.forename: Viola
authors.initials: V
authors.lastname: Pinto
authors.forename: Mario
authors.initials: M
authors.lastname: Ferrario
authors.forename: Jorge
authors.initials: J
authors.lastname: Rodríguez
authors.forename: Gabriel
authors.initials: G
authors.lastname: Cavada
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000911:Antibodies, Monoclonal / Q000008:administration & dosage; D000077552:Basiliximab; D001827:Body Height / Q000187:drug effects; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D016030:Kidney Transplantation; D008297:Male; D011993:Recombinant Fusion Proteins / Q000008:administration & dosage
chemical_list: D000305:Adrenal Cortex Hormones; D000911:Antibodies, Monoclonal; D007166:Immunosuppressive Agents; D011993:Recombinant Fusion Proteins; D000077552:Basiliximab