title: Long-term experience of steroid-free pediatric renal transplantation: effects on graft function, body mass index, and longitudinal growth.
abstract: Increased focus on the potential negative side effects of steroid usage in pediatric transplantation has led to steroid minimization or steroid-free transplantation. In this study, we report results after complete steroid avoidance in renal transplantation in the period 1994-2009. We evaluate the effects of complete steroid avoidance on allograft function, BMI, and linear growth. The majority of transplanted children were induced with antithymocyte globulin and immunosuppressed with a calcineurin inhibitor and mycophenolate mofetil. Steroids were given only when rejection occurred or due to comorbidities. Anthropometric data were collected from 65 transplantations in 60 children. Patient survival was 93%; graft survival was 81% after five yr (N = 42) and 63% after 10 yr (N = 16). Acute rejection within the first year of transplantation was 9%. The distribution of the children's BMI before transplantation was normal; the mean BMI-SDS was 0.21 before transplantation, and this value remained stable during the next five yr. Post-transplantation the children demonstrated significant improved growth as the mean height-SDS increased significantly from -1.7 to -1.1. Catch-up growth was most pronounced in the youngest (< six yr). Steroid-free immunosuppression in pediatric renal transplantation is safe and protects against steroid-induced obesity and short stature.
authors.affiliation: Department of Nephrology, Odense University Hospital, Odense, Denmark.
authors.forename: Per
authors.initials: P
authors.lastname: Wittenhagen
authors.forename: Helle C
authors.initials: HC
authors.lastname: Thiesson
authors.forename: François
authors.initials: F
authors.lastname: Baudier
authors.forename: Erik B
authors.initials: EB
authors.lastname: Pedersen
authors.forename: Mette
authors.initials: M
authors.lastname: Neland
mesh_terms: D000293:Adolescent; D000886:Anthropometry; D000961:Antilymphocyte Serum / Q000627:therapeutic use; D015992:Body Mass Index; D065095:Calcineurin Inhibitors; D002648:Child; D002675:Child, Preschool; D005260:Female; D005919:Glomerular Filtration Rate; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007223:Infant; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D009765:Obesity / Q000150:complications; D051437:Renal Insufficiency / Q000401:mortality* / Q000628:therapy*; D012189:Retrospective Studies; D013256:Steroids / Q000009:adverse effects*; D016896:Treatment Outcome
chemical_list: D000961:Antilymphocyte Serum; D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D013256:Steroids; D009173:Mycophenolic Acid
keywords: body mass index; graft survival; growth; steroid-free; transplantation