Effects of steroid avoidance and novel protocols on growth in paediatric renal transplant patients

Area of Science:

• Nephrology
• Immunology
• Pediatric Transplantation

Background:

• Kidney transplant recipients typically receive triple immunosuppression including steroids.
• Steroids are effective against graft rejection but cause significant toxicity, notably growth retardation in children.
• Reducing steroid exposure is a key goal in pediatric kidney transplantation.

Purpose of the Study:

• To evaluate therapeutic strategies aimed at decreasing steroid exposure in kidney transplant recipients.
• To assess the safety and efficacy of steroid withdrawal or avoidance protocols.
• To determine the impact of reduced steroid exposure on post-transplantation growth, particularly in pediatric patients.

Main Methods:

• Review of single- and multicentre studies on alternate day steroid administration, rapid/late withdrawal, and complete avoidance.
• Analysis of the Stanford study employing tacrolimus, mycophenolate mofetil, and daclizumab for steroid avoidance.
• Examination of the international randomized TWIST trial data.

Main Results:

• Steroid withdrawal and avoidance strategies show clinical advantages in reducing specific adverse events.
• Complete steroid avoidance, supported by specific immunosuppressive regimens, demonstrated improved post-transplantation growth in the Stanford study.
• The TWIST trial reported significant growth improvement in pediatric renal graft recipients within 6 months.

Conclusions:

• Therapeutic approaches to decrease steroid exposure are beneficial for kidney transplant recipients.
• Complete steroid avoidance protocols, when combined with appropriate immunosuppression and induction therapy, appear effective and safe for improving growth in pediatric kidney transplant recipients.
• These strategies hold promise for enabling pediatric patients to avoid steroid-related toxicity.