Good Growth after Steroid-Free Transplantation in Kids

For children undergoing kidney transplantation, steroid-free immunosuppression is safe and reduces the long-term risks of obesity and short stature, reports a study in Pediatric Transplantation.

The researchers report on the outcomes of a strategy of complete steroid avoidance after pediatric renal transplantation. The analysis included 65 transplants in 60 patients performed in one Danish hospital from 1994 through 2009. Most patients received antithymocyte globulin for induction; for immunosuppression they received a calcineurin inhibitor and mycophenolate mofetil. The only indications for steroids were rejection or comorbid conditions.

Sixty percent of patients were male; the mean age at transplantation was 9.5 years. Mortality was 7 percent. Graft survival was 81 percent after 5 years and 63 percent after 10 years. There was a 9 percent rate of acute rejection within the first year after transplantation. Twenty-nine percent of children received steroids at some point during follow-up, most commonly for acute clinical rejection.

The children had a normal distribution of body mass index (BMI) before transplantation. Their mean pretransplantation BMI standard deviation score (SDS) of 0.21 remained stable over the subsequent 5 years. Growth improved significantly after transplantation; the mean height SDS increased from −1.7 to −1.1. Children younger than 6 years had the greatest catch-up growth; their height SDS increased from −2.1 to −0.9.

Alternative strategies have been developed to avoid the side effects of steroids in children undergoing organ transplantation. Steroid-free immunosuppression has shown good results in terms of graft function and rejection rates in children receiving kidney transplants.

This long-term follow-up shows that steroid-free transplantation not only is medically safe but also improves growth while controlling the development of obesity. Catch-up growth is particularly favorable in the youngest transplant recipients [Wittenhagen P, et al. Long-term experience of steroid-free pediatric renal transplantation: effects on graft function, body mass index, and longitudinal growth. Pediatr Transplant 2014; 18:35–41].

March 2014 (Vol. 6, Number 3)