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Published on: April 12, 2021

Steroid withdrawal in pediatric and adult renal transplant recipients

Burkhard Tönshoff1, Britta Höcker, Lutz T Weber

  • 1University Children's Hospital, Im Neuenheimer Feld 153, 69120 Heidelberg, Germany. Burkhard.Toenshoff@med.uni-heidelberg.de

Pediatric Nephrology (Berlin, Germany)
|January 15, 2005
PubMed

Insights

Late steroid withdrawal is safe and effective in pediatric kidney transplant patients on cyclosporine and mycophenolate mofetil. This approach minimizes steroid side effects without increasing rejection risk.

Area of Science:

  • Pediatric Nephrology
  • Transplantation Immunology
  • Pharmacology

Background:

  • Corticosteroids are essential for immunosuppression in pediatric kidney transplant recipients but cause significant side effects.
  • Previous steroid-sparing attempts with cyclosporine (CsA) and azathioprine (AZA) increased acute rejection risk.
  • Mycophenolate mofetil (MMF) offers potent immunosuppression, renewing interest in steroid-sparing protocols.

Purpose of the Study:

  • To evaluate the safety and efficacy of late steroid withdrawal in pediatric renal transplant recipients.
  • To determine if steroid withdrawal can reduce steroid-associated side effects without compromising graft survival.
  • To assess the impact of MMF's potency on the success of steroid-sparing regimens.

Main Methods:

  • Retrospective case control study involving 40 pediatric renal transplant recipients.
  • Patients maintained on immunosuppressive therapy with cyclosporine (CsA) and mycophenolate mofetil (MMF).
  • Late steroid withdrawal was implemented (>= 6 months post-transplant) in stable patients.

Main Results:

  • Late steroid withdrawal was found to be safe and successful in this cohort.
  • No increased rate of acute rejection episodes was observed post-steroid withdrawal.
  • This suggests MMF's higher potency compared to AZA facilitates successful steroid minimization.

Conclusions:

  • Late steroid withdrawal is a viable strategy for stable pediatric renal transplant recipients on CsA and MMF.
  • This approach effectively mitigates steroid-related adverse effects.
  • Prospective randomized trials are underway to further validate these findings.

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