title: Improved cardiovascular risk factors in pediatric renal transplant recipients on steroid avoidance immunosuppression: A study of the Midwest Pediatric Nephrology Consortium.
abstract: Several centers have examined the implementation of immunosuppression protocols that minimize steroid exposure. This study retrospectively examined cardiovascular risk factors in 70 pediatric renal transplant recipients on steroid avoidance-based immunosuppression over three yr compared to matched pediatric patients maintained on chronic corticosteroids. Although higher rates of acute rejection were noted in the steroid-avoidant group (22% vs. 16%, p = 0.034), graft function was similar (67 + 10 mL/min/1.73 m(2) vs. 72 + 12 mL/min/1.73 m(2)) (p = 0.053). The steroid-avoidant group demonstrated improved growth (height z-score -0.41 + 5.9 vs. -1.1 + 0.041) with a decrease in the prevalence of obesity (24% vs. 34%, p = 0.021). Indexed systolic blood pressures were lower beginning at six months post-transplant in the steroid-avoidant group (1.21 + 0.15 vs. 1.51 + 0.22, p = 0.020). Indexed diastolic blood pressures were lower beginning at 12 months post-transplant (0.91 + 0.11 vs. 1.12 + 0.18, p = 0.037). Differences in total serum cholesterol values and serum glucose values were not statistically significant. Beginning at 12 months, a statistically significant decrease in left ventricular mass index (39.2 + 11.3 vs. 49.4 + 14.5, p = 0.014) was noted in patients on steroid-avoidant immunosuppression, which corresponded to a significant decrease in the prevalence of left ventricular hypertrophy in these patients by two yr post-transplant (35% vs. 48%, p = 0.012). Systolic blood pressure and BMI were independent predictors of left ventricular hypertrophy.
authors.affiliation: Division of Nephrology and Hypertension, Department of Pediatrics, Levine Children's Hospital at Carolinas Medical Center, Charlotte, NC, USA.
authors.forename: Donald J
authors.initials: DJ
authors.lastname: Weaver
authors.affiliation: Division of Nephrology, Department of Pediatrics, C.S. Mott Children's Hospital, Ann Arbor, MI, USA.
authors.forename: David
authors.initials: D
authors.lastname: Selewski
authors.affiliation: Division of Nephrology, Cleveland Clinic Children's Hospital, Cleveland, OH, USA.
authors.forename: Halima
authors.initials: H
authors.lastname: Janjua
authors.affiliation: Division of Nephrology, Louisiana State University Health Sciences Center, New Orleans, LA, USA.
authors.forename: Franca
authors.initials: F
authors.lastname: Iorember
mesh_terms: D000293:Adolescent; D001786:Blood Glucose / Q000032:analysis; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000150:complications* / Q000517:prevention & control; D002648:Child; D002675:Child, Preschool; D002784:Cholesterol / Q000097:blood; D003971:Diastole / Q000187:drug effects; D005260:Female; D006084:Graft Rejection; D006801:Humans; D007165:Immunosuppression Therapy; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016030:Kidney Transplantation; D008297:Male; D015146:Midwestern United States; D009398:Nephrology; D009765:Obesity / Q000150:complications; D010372:Pediatrics; D011184:Postoperative Period; D051437:Renal Insufficiency / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D012984:Software; D013256:Steroids / Q000627:therapeutic use*; D013599:Systole / Q000187:drug effects; D016896:Treatment Outcome; D016277:Ventricular Function, Left
chemical_list: D001786:Blood Glucose; D007166:Immunosuppressive Agents; D013256:Steroids; D002784:Cholesterol
keywords: left ventricular hypertrophy; renal transplantation; steroid-free immunosuppression