Corticosteroid Use and Growth After Pediatric Solid Organ Transplantation

Tsampalieros, Anne; Knoll, Greg; Molnar, Amber O.; Fergusson, Nicholas A; Fergusson, Dean

doi:10.1097/tp.0000000000001320

Cited by 38 publications

(31 citation statements)

References 35 publications

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“…Estimated GFR (eGFR, updated Schwartz formula) based on centrally recorded observed values. Box plots represent median and interquartile range; means are connected by lines; whiskers extend to the 10th and 90th percentile; dots represent outliers.…”

Section: Resultsmentioning

confidence: 99%

“…Children are exposed to immunosuppression for longer, increasing their risk for malignancies, viral infections, and CNI‐related renal and metabolic complications such as diabetes. In addition, “standard” immunosuppressive protocols with long‐term corticosteroid use impairs longitudinal growth and contributes to metabolic derangements that have cardiovascular consequences …”

Section: Introductionmentioning

confidence: 99%

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Early conversion of pediatric kidney transplant patients to everolimus with reduced tacrolimus and steroid elimination: Results of a randomized trial

Tönshoff

Ettenger

Strologo

et al. 2019

American Journal of Transplantation

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In a 12-month, multicenter, open-label study, 106 children were randomized at 4 to 6 weeks after kidney transplantation to switch to everolimus with reduced TAC (EVR/rTAC) and steroid elimination from month 5 posttransplant or to continue standard tacrolimus with mycophenolate mofetil (sTAC/MMF) and steroids. The cumulative incidence of a co-primary efficacy end point (biopsy-proven acute rejection [BPAR], graft loss, or death from randomization to month 12) was 10.3% with EVR/rTAC and 5.8% with sTAC/MMF (difference 4.4%; P = .417). BPAR occurred in 9.6% and 5.6% of patients, respectively. Patient and renal allograft survival were 100%. The co-primary end point of mean estimated glomerular filtration rate at month 12 was 76.2 mL/min/1.73 m with EVR/rTAC and 72.5 mL/min/1.73 m for sTAC/MMF (difference 3.8 mL/min/1.73m ; P = .49). One EVR/rTAC patient developed posttransplant lymphoproliferative disease. Longitudinal growth and sexual maturation were equivalent between groups. The randomized drug regimen was discontinued in 34.6% and 13% of patients in the EVR/rTAC and sTAC/MMF groups, respectively (P = .024), and discontinued due to adverse events/infections in 25.0% and 11.1% of patients (P = .062). In conclusion, early conversion of pediatric kidney transplant patients from TAC, MMF, and steroids to EVR/rTAC and steroid withdrawal maintains immunosuppressive efficacy and preserves renal function.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Early conversion of pediatric kidney transplant patients to everolimus with reduced tacrolimus and steroid elimination: Results of a randomized trial

Tönshoff

Ettenger

Strologo

et al. 2019

American Journal of Transplantation

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“…Because each center has a small number of recipients in each of those increased risk subgroups, single‐center studies provide limited information. Analyses, to date, suggest that in those higher‐risk subgroups, RDP did not decrease patient or graft survival rates .…”

Section: Discussionmentioning

confidence: 89%

“… reported that RDP was not associated with an increased risk of graft loss to disease recurrence. Additionally, two recent multicenter prospective randomized studies, as well as two recent reviews and meta‐analyses—all involving pediatric recipients—found no difference in patient and graft survival rates in RDP versus maintenance prednisone recipients .…”

Section: Discussionmentioning

confidence: 98%

Rapid discontinuation of prednisone in kidney transplant recipients from at‐risk subgroups: an OPTN/SRTR analysis

Vock

Matas

2019

Transpl Int

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Summary Although rapid discontinuation of prednisone (RDP) after kidney transplantation has been successful in low‐risk recipients, there is concern about RDP use in recipients at increased risk for rejection or recurrent disease. Using SRTR, we compared outcomes for RDP versus maintenance prednisone‐treated recipients for all adult 1st and 2nd transplants (n = 169 479) and the following 1st transplant subgroups: African American (AA); highly sensitized; those with a potentially recurrent disease; and pediatric recipients. For all adult 1st LD and DD transplants, RDP was associated with better patient and graft survival. For all LD subgroups, RDP and maintenance prednisone were associated with similar patient, graft, and death‐censored (DC) graft survival. For 1st transplant DD subgroups, RDP was associated with better patient survival in AA, those with potentially recurrent disease, and pediatric recipients; graft survival with RDP was better in AAs. For adult 2nd DD transplants, RDP was associated with worse DC‐graft survival. Importantly, for all differences, the effect size was small. With the exception of 2nd DD transplants, RDP protocols can be used without decreasing patient or graft survival for subgroups of 1st DD and LD kidney transplant recipients and for 2nd LD transplant recipients, at increased risk of rejection or recurrent disease.

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“…25 less favored because of their effects on growth. 26,27 Avoiding corticosteroids after transplantation can significantly increase a child's height without adversely affecting rejection, graft loss, or patient survival rates. 28 Our patient who had a history of cytomegalovirus infection prior to transplantation was treated with oral valganciclovir, and the subsequent reactivation was assumed to have been caused by excessive immunosuppression from the corticosteroids (Figure 1).…”

Section: Patient Outcomesmentioning

confidence: 99%

Experience of the first 6 years of pediatric kidney transplantation in Indonesia: A multicenter retrospective study

Ambarsari

Hidayati

Trihono

et al. 2020

Pediatric Transplantation

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Background: Pediatric kidney transplantation was only introduced in Indonesia in 2013. We therefore aimed to assess the characteristics and outcomes of transplants performed from its inception to January 2019. Method: The study had a dual-center retrospective design. We examined the records of kidney transplant recipients and then calculated patient and graft survival rates by Kaplan-Meier survival analysis with 95% confidence intervals (95% CI). Results: In total, 12 kidney transplantations were performed in eleven children during the study period; among these, ten were boys, and nine had renal failure caused by congenital anomaly of the kidney or urinary tract. All donors were living, and all recipients were on dialysis at the time of transplantation, when their median age was 14.5 years (range, 8-19 years). Three patients died of infection in the first year of follow-up and two lost their allograft by the time of their last follow-up (median, 13 months; range, 4-69 months). The 1-year patient survival rate was therefore 68.18% (95% CI, 29.72%-88.61%), which remained unchanged at 3 and 5 years. However, the non-death-censored graft survival rates at 1, 3, and 5 years were 68.18% (95% CI, 29.72%-88.61%), 51.14% (95% CI, 14.5%-79.46%), and 25.57% (95% CI, 1.38%-64.78%), respectively. Conclusion: Patient and graft survival rates after pediatric kidney transplantation in Indonesia are lower than those reported in other countries. Closer patient follow-up and stricter adherence to guidelines could improve transplant outcomes, but we must seek to improve the balance between infection and rejection.

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Corticosteroid Use and Growth After Pediatric Solid Organ Transplantation

Cited by 38 publications

References 35 publications

Early conversion of pediatric kidney transplant patients to everolimus with reduced tacrolimus and steroid elimination: Results of a randomized trial

Early conversion of pediatric kidney transplant patients to everolimus with reduced tacrolimus and steroid elimination: Results of a randomized trial

Rapid discontinuation of prednisone in kidney transplant recipients from at‐risk subgroups: an OPTN/SRTR analysis

Experience of the first 6 years of pediatric kidney transplantation in Indonesia: A multicenter retrospective study

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