Top

Published in:

01-11-2007 | Original Article

Selective late steroid withdrawal after renal transplantation

Authors: Guido F. Laube, Jutta Falger, Markus J. Kemper, Andrea Zingg-Schenk, Thomas J. Neuhaus

Published in: Pediatric Nephrology | Issue 11/2007

Abstract

Steroid withdrawal (SW) after paediatric renal transplantation (RTPL) is controversial. Selective late SW has been performed in our unit since 1995. The safety and effects of SW were analysed retrospectively in 47 patients undergoing RTPL between 1995 and 2004. Initial immunosuppression consisted of cyclosporine A, azathioprine or mycophenolate mofetil and steroids. Criteria for SW were: (1) stable renal function, (2) time interval after RTPL ≥ 1 year, (3) no rejection or time interval after last rejection ≥ 1 year and (4) good compliance. SW was performed in 30 patients at an age of 13.5 years (range 4.5–18.5) and 2.2 years (range 1–6.6) after RTPL. After SW, one patient experienced a steroid-sensitive rejection. Follow-up after SW (1.3 year; range 0.25–7.5) showed maintained renal function: glomerular filtration rate at SW and currently was 82 (65–128) and 82 (42–115) ml/min per 1.73 m², respectively. The number of patients on antihypertensive treatment did not significantly change (at SW: n = 15; currently: n = 11). Height and body mass index (BMI) remained stable: Median standard deviation score (SDS) for height/BMI at SW and currently was −1.1/0.2 and −0.8/0.1, respectively. Selective late SW was safe regarding renal function and had no significant effect on blood pressure and growth.

Tonshoff B, Mehls O (1997) Factors affecting growth and strategies for treatment in children after renal transplantation. Pediatr Transplant 1:176–182PubMed

Acott PD, Crocker JF, Wong JA (2003) Decreased bone mineral density in the pediatric renal transplant population. Pediatr Transplant 7:358–363CrossRef

Vidhun JR, Sarwal MM (2005) Corticosteroid avoidance in pediatric renal transplantation. Pediatr Nephrol 20:418–426CrossRef

Oberholzer J, John E, Lumpaopong A, Testa G, Sankary HN, Briars L, Kraft KA, Knight PS, Verghese P, Benedetti E (2005) Early discontinuation of steroids is safe and effective in pediatric kidney transplant recipients. Pediatr Transplant 9:456–463CrossRef

Ellis D (2000) Growth and renal function after steroid-free tacrolimus-based immunosuppression in children with renal transplants. Pediatr Nephrol 14:689–694CrossRef

Motoyama O, Hasegawa A, Ohara T, Satoh M, Shishido S, Honda M, Tsuzuki K, Kinukawa T, Hattori M, Ito K, Ogawa O, Yanagihara T, Saito K, Takahashi K, Ohshima S (2005) A prospective trial of steroid withdrawal after renal transplantation treated with cyclosporine and mizoribine in children: results obtained between 1990 and 2003. Pediatr Transplant 9:232–238CrossRef

Chakrabarti P, Wong HY, Scantlebury VP, Jordan ML, Vivas C, Ellis D, Lombardozzi-Lane S, Hakala TR, Fung JJ, Simmons RL, Starzl TE, Shapiro R (2000) Outcome after steroid withdrawal in pediatric renal transplant patients receiving tacrolimus-based immunosuppression. Transplantation 70:760–764CrossRef

Jensen S, Jackson EC, Riley L, Reddy S, Goebel J (2003) Tacrolimus-based immunosuppression with steroid withdrawal in pediatric kidney transplantation-4-year experience at a moderate-volume center. Pediatr Transplant 7:119–124CrossRef

Hocker B, John U, Plank C, Wuhl E, Weber LT, Misselwitz J, Rascher W, Mehls O, Tonshoff B (2004) Successful withdrawal of steroids in pediatric renal transplant recipients receiving cyclosporine A and mycophenolate mofetil treatment: results after four years. Transplantation 78:228–234CrossRef

10.

Silverstein DM, Aviles DH, LeBlanc PM, Jung FF, Vehaskari VM (2005) Results of one-year follow-up of steroid-free immunosuppression in pediatric renal transplant patients. Pediatr Transplant 9:589–597CrossRef

11.

Sarwal MM, Yorgin PD, Alexander S, Millan MT, Belson A, Belanger N, Granucci L, Major C, Costaglio C, Sanchez J, Orlandi P, Salvatierra O Jr (2001) Promising early outcomes with a novel, complete steroid avoidance immunosuppression protocol in pediatric renal transplantation. Transplantation 72:13–21CrossRef

12.

Pascual J, Quereda C, Zamora J, Hernandez D (2005) Updated metaanalysis of steroid withdrawal in renal transplant patients on calcineurin inhibitor and mycophenolate mofetil. Transplant Proc 37:3746–3748CrossRef

13.

Klaus G, Jeck N, Konrad M, Forster B, Soergel M (2001) Risk of steroid withdrawal in pediatric renal transplant patients with suspected steroid toxicity. Clin Nephrol 56:S37–S42PubMed

14.

Sarwal M (2006) Steroid elimination is coming of age. Pediatr Nephrol 21:2–4CrossRef

15.

Marks SD, Trompeter RS (2006) Steroid preservation: the rationale for continued prescribing. Pediatr Nephrol 21:305–307CrossRef

16.

Tönshoff B, Offner G, Hoecker B, Pape L, Rascher W, Neuhaus T, Hoppe B, Querfeld U, Bulla M, Klaus G, Latta K, Leichter H, Fehrenbach H, Wygoda S, Misselwitz J, Montoya C, Mueller-Wiefel D, Foulard M, Hoyer P, Cochat P, Fischer W, Zimmerhackl LB (2006) A multicenter, placebo-controlled trial evaluating the efficacy and safety of Basiliximab (Simulect) in combination with CsA, MMF and steroids in pediatric renal allograft recipients: 12 months results. Pediatr Nephrol 21:1513 (abstract)

17.

Chantler C, Barratt TM (1972) Estimation of glomerular filtration rate from plasma clearance of 51-chromium edetic acid. Arch Dis Child 47:613–617CrossRef

18.

National High Blood Pressure Education Working Group on High Blood Pressure in Children and Adolescents (2004) The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 114 (2 Suppl):555–576

19.

Mitsnefes MM, Khoury PR, McErny PT (2003) Early posttransplantation hypertension and poor long-term renal allograft survival in pediatric patients. J Pediatr 143:98–103CrossRef

20.

Prader A, Largo RH, Molinari L, Issler C (1989) Physical growth of Swiss children from birth to 20 years of age. First Zurich longitudinal study of growth and development. Helv Paediatr Acta Suppl 52:1–125PubMed

21.

Cattaneo D, Perico N, Gaspari F, Gotti E, Remuzzi G (2002) Glucocorticoids interfere with mycophenolate mofetil bioavailability in kidney transplantation. Kidney Int 62:1060–1067CrossRef

22.

Caillard S, Dharnidharka V, Agodoa L, Bohen E, Abbott K (2005) Posttransplant lymphoproliferative disorders after renal transplantation in the United States in era of modern immunosuppression. Transplantation 80:1233–1243CrossRef

23.

Mitsnefes MM (2004) Hypertension and end-organ damage in pediatric renal transplantation. Pediatr Transplant 8:394–399CrossRef

24.

El-Husseini AA, Foda MA, Shokeir AA, Shehab El-Din AB, Sobh MA, Ghoneim MA (2005) Determinants of graft survival in pediatric and adolescent live donor kidney transplant recipients: a single center experience. Pediatr Transplant 9:763–769CrossRef

25.

Watson AR (2000) Non-compliance and transfer from paediatric to adult transplant unit. Pediatr Nephrol 14:469–472CrossRef

26.

Neu AM (2006) Special issues in pediatric kidney transplantation. Adv Chronic Kidney Dis 13:62–69CrossRef

Title: Selective late steroid withdrawal after renal transplantation
Authors: Guido F. Laube
Jutta Falger
Markus J. Kemper
Andrea Zingg-Schenk
Thomas J. Neuhaus
Publication date: 01-11-2007
Publisher: Springer Berlin Heidelberg
Published in: Pediatric Nephrology / Issue 11/2007
Print ISSN: 0931-041X
Electronic ISSN: 1432-198X
DOI: https://doi.org/10.1007/s00467-007-0576-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Selective late steroid withdrawal after renal transplantation

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 11/2007

Low birth weight, but not postnatal weight gain, aggravates the course of nephrotic syndrome

Severe acute renal failure in a child: a rare complication of anicteric leptospirosis

Acute focal bacterial nephritis in 25 children

Ocular involvement in hemolytic uremic syndrome due to factor H deficiency—are there therapeutic consequences?

Molecular regulation of kidney development: is the answer blowing in the Wnt?

Protracted remission of proteinuria after combined therapy with plasmapheresis and anti-CD20 antibodies/cyclophosphamide in a child with oligoclonal IgM and glomerulosclerosis