title: Steroid withdrawal in pediatric kidney transplant allows better growth, lipids and body composition: a randomized controlled trial.
abstract: BACKGROUND
  Glucocorticoid immunosuppressant therapy in pediatric kidney transplant (Tx) recipients does not allow the improvement of growth after Tx.
  
  
  OBJECTIVE
  To determine the effect of early steroid withdrawal (SW) on longitudinal growth, insulin sensitivity (IS), and body composition (BC).
  
  
  METHODS
  This was a prospective, randomized, multicenter study in Tx. Insulin-like growth factor (IGF)-I, IGF-binding protein 3 (IGFBP3), IS, and BC (DEXA/pQCT) were determined at baseline and up to 12 months after Tx.
  
  
  RESULTS
  A total of 30 patients were examined; 14 patients were assigned to the SW group (7 male, 7 female; 12 in Tanner stage I) and 16 patients were assigned to the steroid control (SC) group (10 male, 6 female;12 in Tanner stage I). Their chronological age was 7.8 ± 4.3 years, height was -2.3 ± 0.99 SD scores (SDS), and body mass index -0.3 ± 1.2 SDS. After 1 year, the SW group showed an increase in height SDS (+1.2 ± 0.22 vs. +0.60 ± 0.13 SDS in the SC group, p < 0.02), lower IGFBP3 (p < 0.05), cholesterol (p < 0.05), and higher high-density lipoprotein cholesterol (p < 0.05). SW patients had lower trunk fat with no differences in IS. Only in prepubertal patients, the SW group had lower glycemia (p < 0.05), very low-density lipoprotein cholesterol (p < 0.01), triglycerides (p < 0.05), triglycerides/glycemia index (TyG; p < 0.02), and better lean mass. Both groups showed an improvement in lean mass after kidney Tx.
  
  
  CONCLUSIONS
  SW improved longitudinal growth, lipid profile, and trunk and lean fat in Tx patients. In prepubertal recipients, the decrease in TyG suggests better IS.
authors: Institute of Maternal and Child Research, University of Chile, Santiago, Chile.
authors: Veronica
authors: V
authors: Mericq
authors: Paulina
authors: P
authors: Salas
authors: Viola
authors: V
authors: Pinto
authors: Francisco
authors: F
authors: Cano
authors: Loreto
authors: L
authors: Reyes
authors: Keenan
authors: K
authors: Brown
authors: Magdalena
authors: M
authors: Gonzalez
authors: Luis
authors: L
authors: Michea
authors: Iris
authors: I
authors: Delgado
authors: Angela
authors: A
authors: Delucchi
mesh_terms: D050154:Adiposity; D001827:Body Height; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D002784:Cholesterol / Q000097:blood*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents; D018972:Insulin-Like Growth Factor Binding Protein 3 / Q000097:blood; D007334:Insulin-Like Growth Factor I / Q000378:metabolism; D016030:Kidney Transplantation; D008297:Male; D011446:Prospective Studies; D013256:Steroids; D013997:Time Factors; D014184:Transplantation, Homologous
chemical_list: C515497:IGFBP3 protein, human; D007166:Immunosuppressive Agents; D018972:Insulin-Like Growth Factor Binding Protein 3; D013256:Steroids; D007334:Insulin-Like Growth Factor I; D002784:Cholesterol