Graft function and metabolic effects of low dose steroid therapy followed by late steroid withdrawal in renal transplant patients

J FERRARIS; T PASQUALINI; G ALONSO; S LEGAL; P SORROCHE; A GALICH; H JASPER

Budapest, Hungary

Congreso; 14th Congress of the International Pediatric Nephrology Association; 2007

International Pediatric Nephrology Association

Side effects result from chronic administration of steroids. The aims of this study are to analyze graft function and metabolic effects of low dose and withdrawal of steroid therapy. This is a single center pilot, one arm and prospective study. Methylprednisone (MP) was decreased to 0.07±0.03 mg/kg/day (low dose) after 4 months. We studied changes in graft function, height velocity, lipid profile, body composition and bone mass after 1 year of low dose MP and after a 2nd year following MP withdrawal. Patients received daclizumab induction; tacrolimus and mycophenolate mofetil. The inclusion criteria was 1st living related graft and PRA <10%; 16 patients were enrolled and total follow-up was 2.5 years. Age at transplantation was 3.1-21 years, 5 females, 9 prepubertal, 7 postpubertal patients. Patients and graft survival were 100%, acute rejection (AR) occurred after 14 months of MP withdrawal in 2/9 (22%) prepubertal patients (Banff 97, 1B). In prepubertal patients, at the moment of steroid withdrawal and 1 year later creatinine clearance was 99.7±15.2 and 82.9±3.9 ml/min/1.73 m2, p<0.001; height velocity 6.9±2.5 and 7.4±2.9 cm/year, p: NS, with a height increment of 0.31±0.1 SDS, p<0.05 during the last year of follow-up. Graft function did not change in postpubertal patients. In all patients at the moment of steroid withdrawal and 1 year later lipid profile was normal; fat body mass 10.0±6.7 and 9.2±5.5 kg, p: NS; lean body mass 29.3±11.4 and 31.7±12.8 kg, p<0.02; total skeleton BMD -1.0±0.6 and -0.7±0.8 SDS, p: NS and lumbar spine BMD -1.3±1.04 and -0.86±0.86 SDS, p<0.05. This study demonstrates that low dose and steroid withdrawal allow catch up growth, normal lipid profile with no fat accumulation. Steroid withdrawal prevents bone loss with increment of lean body mass, but with a concerning rate of AR and graft function deterioration in prepubertal patients.