Related Experiment Video
Updated: May 21, 2026
Robot-Assisted Kidney Transplantation
Published on: July 19, 2021
Complete steroid avoidance is effective and safe in children with renal transplants: a multicenter randomized trial
M M Sarwal1, R B Ettenger, V Dharnidharka
1California Pacific Medical Center, Sutter Health Care, San Francisco, CA, USA. sarwalm@cpmcri.org
Insights
Steroid avoidance in pediatric kidney transplantation is safe and effective, showing no difference in rejection rates. Younger children experienced improved linear growth in the steroid-free group, with better blood pressure and cholesterol levels.
Area of Science:
- Pediatric Nephrology
- Transplantation Immunology
- Clinical Trials
Background:
- Steroids are commonly used in pediatric kidney transplantation but can impair growth.
- Alternative immunosuppression strategies are being explored to mitigate side effects.
Purpose of the Study:
- To evaluate the safety and efficacy of a steroid-free immunosuppression protocol in pediatric kidney transplant recipients.
- To compare growth outcomes, rejection rates, and survival between steroid-free and steroid-based regimens.
Main Methods:
- A randomized, multicenter trial involving 130 children undergoing primary kidney transplantation.
- Patients were assigned to either a steroid-free (SF) or steroid-based (SB) immunosuppression regimen.
- Follow-up was conducted for 3 years post-transplant.
Main Results:
- No significant difference in biopsy-proven acute rejection rates between SF and SB groups (16.7% vs. 17.1%).
- Overall linear growth was similar, but younger children (<5 years) showed improved growth in the SF group.
- Patient survival was 100% in both groups; graft survival was 95% (SF) vs. 90% (SB).
- The SF group exhibited lower systolic blood pressure and cholesterol levels.
Conclusions:
- Complete steroid avoidance is a safe and effective strategy for unsensitized children undergoing primary kidney transplantation.
- Steroid-free protocols may offer benefits in growth and cardiovascular risk factors for pediatric transplant recipients.
Abstract:
To determine whether steroid avoidance in pediatric kidney transplantation is safe and efficacious, a randomized, multicenter trial was performed in 12 pediatric kidney transplant centers. One hundred thirty children receiving primary kidney transplants were randomized to steroid-free (SF) or steroid-based (SB) immunosuppression, with concomitant tacrolimus, mycophenolate and standard dose daclizumab (SB group) or extended dose daclizumab (SF group). Follow-up was 3 years posttransplant. Standardized height Z-score change after 3 years follow-up was -0.99 ± 2.20 in SF versus -0.93 ± 1.11 in SB; p = 0.825. In subgroup analysis, recipients under 5 years of age showed improved linear growth with SF compared to SB treatment (change in standardized height Z-score at 3 years -0.43 ± 1.15 vs. -1.07 ± 1.14; p = 0.019). There were no differences in the rates of biopsy-proven acute rejection at 3 years after transplantation (16.7% in SF vs. 17.1% in SB; p = 0.94). Patient survival was 100% in both arms; graft survival was 95% in the SF and 90% in the SB arms (p = 0.30) at 3 years follow-up. Over the 3 year follow-up period, the SF group showed lower systolic BP (p = 0.017) and lower cholesterol levels (p = 0.034). In conclusion, complete steroid avoidance is safe and effective in unsensitized children receiving primary kidney transplants.
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