| Abstract | dc.description.abstract | Background: Cardiovascular risk, growth failure and the new
immunosuppressive drugs, have encouraged steroid withdrawal or total avoidance with promising
results in renal transplant (Tx) immunosuppression. Aim: To evaluate a new immunosuppressor
protocol with early withdrawal of steroids in pediatric kidney transplant. Patients and methods:
Prospective study in pediatric patients older than 1 year and low immunological risk. Group A (n
=28): steroids in decreasing doses until day 7 post Tx, tacrolimus (FK) and micophenolate mofetil
(MMF). Group B (n =28) control: steroids, cyclosporine and azathioprine or steroids, FK and MMF. In
both groups the induction therapy included basiliximab. Anthropometric and biochemical variables
(renal function, lipid profile, hematological, blood glucose and acid-base equilibrium), acute rejection
and CMV infection, were evaluated. Mean values and variations for continuous variables were
calculated at months 1, 6, 12 and 18. Results: Two children were withdrawn before month 2, one
had an untreatable diarrhea and the second died due to Aspergillus septicemia. Mean values at
months 1, 6, 12 and 18 for groups A and B: Creatinine clearence (ml/min): 85.4 vs 89; 79.9 vs 83; 89
vs 80; 79.8 vs 80.6 (p: ns); hematocrit (%): 28.8 vs 30.4; 31.7 vs 34.4; 34.4; 32.4 vs 34.8; 34.4 vs 35.5
(p: ns). Total cholesterol (mg/dl): 151 vs 206; 139 vs 174; 138 vs 186; 140 vs 180 (p <0.05). Mean delta
height/age Z score at the first year: 0.5 vs 0.15; 0.7 vs 0.22; 0.97 vs 0.25 (p <0.05). Mean systolic blood
pressure Z score: 0.9 vs 1.5; 0.5 vs 0.9; -0.3 vs 0.8; 0.1 vs 1.0 (p <0.05). The height/age Z score was
significantly superior in patients without steroids. A normalization of growth patterns at month 18 was
observed (< 0.05). Both groups presented a negative variation of creatinine clearance during the
follow-up, but it was minor in the study group (p <0.05). Two acute rejections were found in each
group, and no difference in CMV infections was observed. Conclusions: Early steroid withdrawal in
pediatric renal transplant recipients was effective and safe and did not increase the risk of rejection. | en |
