Related Experiment Videos
Pediatric renal transplantation without steroids
S A Birkeland1, K E Larsen, N Rohr
1Department of Nephrology, Tissue Culture Laboratory, Odense University Hospital, Denmark.
Insights
Steroid-free immunosuppression in pediatric kidney transplant patients promotes healthy growth. This approach avoids growth inhibition and reduces rejection risks associated with standard steroid therapies.
Area of Science:
- Pediatric Nephrology
- Transplantation Immunology
- Immunosuppressive Therapy
Background:
- Standard immunosuppressive triple therapy in pediatric renal transplant recipients often includes steroids.
- Steroid use is associated with inhibited post-transplant growth in children.
- Conventional therapies may require steroid reduction, increasing rejection risk.
Purpose of the Study:
- To evaluate the efficacy and outcomes of a steroid-free immunosuppression protocol in pediatric renal allograft recipients.
- To assess the impact of steroid-free immunosuppression on patient growth and graft survival.
- To compare the steroid-free approach with conventional steroid-containing regimens.
Main Methods:
- Retrospective analysis of 14 pediatric renal allograft recipients on a steroid-free protocol since 1990.
- Initial immunosuppression included anti-lymphocyte globulin and cyclosporine.
- Maintenance immunosuppression involved cyclosporine, with mycophenolate mofetil (MMF) in 7 patients.
Main Results:
- All patients demonstrated significant growth and experienced a growth spurt.
- Graft survival was achieved in the majority of patients.
- Early acute cellular rejection occurred in 3 patients, successfully treated with OKT3 or MMF; no late rejections were observed.
- One patient died from Epstein-Barr virus-induced lymphoproliferative disorder.
Conclusions:
- Steroid-free immunosuppression is a beneficial and effective protocol for pediatric renal transplant recipients.
- This regimen promotes normal growth and growth spurts, overcoming a major limitation of steroid-based therapies.
- The steroid-free protocol appears superior to conventional triple therapies, reducing growth inhibition and risks of acute rejection.
Abstract:
Pediatric renal transplant patients present a number of challenges and problems, especially the inhibited post-transplant growth seen in children receiving standard immunosuppressive triple therapy that includes steroids. We report the successful use of steroid-free immunosuppression since 1990 in 14 pediatric renal allograft recipients who received a 10-day initial course of anti-lymphocyte globulin and surface area-adjusted doses of cyclosporine, 7 of whom also received mycophenolate mofetil (MMF) as maintenance immunosuppression. Only 1 patient died (3 months after transplantation as a result of a primary Epstein-Barr virus infection-induced lymphoproliferative disorder), 1 patient's graft never functioned, and another patient lost his graft after 3 years because of chronic rejection. Three patients experienced early acute cellular rejection, which resolved in 2 cases with OKT3, and in the 3rd with MMF. There were no late acute rejections. All patients evidenced growth and a growth spurt under this regimen. We conclude that all the pediatric patients benefited from our steroid-free protocol and that this protocol is superior to conventional triple therapies, which entail the eventual reduction and discontinuation of steroids, a procedure that not only inhibits growth but also carries an additional risk of acute rejection due to a steroid-adapted immune response.