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Corticosteroid Use and Growth After Pediatric Solid Organ Transplantation: A Systematic Review and Meta-Analysis

Anne Tsampalieros1, Greg A Knoll, Amber O Molnar

  • 11 Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada. 2 Division of Nephrology, Children's Hospital of Eastern Ontario, Ottawa, Canada. 3 Division of Nephrology, Kidney Research Centre, Department of Medicine, University of Ottawa, Ottawa, Canada. 4 Division of Nephrology, Department of Medicine, McMaster University, Hamilton, Canada.

Transplantation
|October 14, 2016
PubMed

Insights

Corticosteroid avoidance in pediatric organ transplant recipients significantly improves height, especially in prepubertal children. This approach did not increase risks of rejection or death.

Area of Science:

  • Pediatric transplantation
  • Immunosuppression therapy
  • Growth and development

Background:

  • Corticosteroid minimization and avoidance protocols are established for post-solid organ transplant care.
  • The impact of these protocols on growth and safety in pediatric recipients requires examination.

Purpose of the Study:

  • To evaluate the effect of corticosteroid withdrawal or avoidance on growth parameters in pediatric solid organ transplant recipients.
  • To assess the safety of corticosteroid minimization strategies in this population.

Main Methods:

  • A systematic review of randomized controlled trials (RCTs) and observational studies was conducted.
  • Studies compared corticosteroid withdrawal/avoidance to corticosteroid use in pediatric transplant recipients, focusing on growth outcomes.
  • Data abstraction and quality assessment were performed by two independent reviewers.

Main Results:

  • Corticosteroid withdrawal/avoidance significantly increased growth in pediatric renal transplant recipients (RCTs: +0.18 SDS height; observational: +0.34 SDS height).
  • Prepubertal children showed the most pronounced growth improvement (0.28 SDS height).
  • No significant increase in acute rejection, graft failure, or death was observed in renal trials.

Conclusions:

  • Corticosteroid withdrawal/avoidance in pediatric renal transplantation leads to significant height improvement, particularly in prepubertal children.
  • This strategy appears safe in the short term, without compromising patient or allograft survival.
  • Further research may explore long-term outcomes and optimal protocols.
Abstract

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