Improved long-term graft function and similar height changes with very low dose steroids versus late steroids withdrawal in pediatric renal transplantation

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

Istanbul, Turkey

Congreso; 5th Congress of the International Pediatric Transplant Association; 2009

International Pediatric Transplant Association

Allograft function and metabolic effects of four treatment regimens, namely, methylprednisone (MP) standard dose (MP-STD), deflazacort (DFZ), MP-late steroid withdrawal (MP-LSW), and MP-very low dose (MP-VLD), were evaluated in prepubertal patients. MP was decreased by month 4 post-transplantation to 0.2 mg/kg/day in MPSTD and DFZ patients and to <0.1 mg/kg/day in MP-LSW and MP-VLD patients. Starting in month 16 posttransplant, MP was switched to DFZ in the DFZ group and totally withdrawn in the MP-LSW group. Creatinine clearance diminished in the MP-STD and MP-LSW groups from 77±6 to 63±6 ml/min/1.73 m2and from 103±5 to 78± 3 ml/min/1.73 m2, respectively (p<0.01 and p<0.001, respectively). Height increased >0.5 SDS only in the MPLSW and MP-VLD groups. The body mass index and fat body mass for height-age increased only in the MP-STD patients (p<0.05 and p <0.01, respectively). Fat body mass decreased in the DFZ group (p<0.05), total cholesterol and LDL-cholesterol increased in the MP-STD group, while LDL-cholesterol and total cholesterol/HDL-cholesterol ratio decreased in the DFZ group (p<0.01). Lumbar spine bone mineral density (BMD) for height-age showed an increase in the MP-LSW and MP-VLD groups (p<0.01). Our data suggest that MP-LSW and MP-VLD strategies improve linear growth, BMD, the peripheral distribution of fat, and preservation of the bone–muscle unit and maintain the normal lipid profile. The MP-LSW patients had a concerning rate of acute rejections and graft function deterioration in prepubertal patients. 2and from 103±5 to 78± 3 ml/min/1.73 m2, respectively (p<0.01 and p<0.001, respectively). Height increased >0.5 SDS only in the MPLSW and MP-VLD groups. The body mass index and fat body mass for height-age increased only in the MP-STD patients (p<0.05 and p <0.01, respectively). Fat body mass decreased in the DFZ group (p<0.05), total cholesterol and LDL-cholesterol increased in the MP-STD group, while LDL-cholesterol and total cholesterol/HDL-cholesterol ratio decreased in the DFZ group (p<0.01). Lumbar spine bone mineral density (BMD) for height-age showed an increase in the MP-LSW and MP-VLD groups (p<0.01). Our data suggest that MP-LSW and MP-VLD strategies improve linear growth, BMD, the peripheral distribution of fat, and preservation of the bone–muscle unit and maintain the normal lipid profile. The MP-LSW patients had a concerning rate of acute rejections and graft function deterioration in prepubertal patients.