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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.

Pediatric Nephrology (Berlin, Germany)
|April 16, 1998
PubMed
Summary

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.

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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.

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  • 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.