Growth after conversion to alternate-day corticosteroids in children with renal transplants: a single-center study

Kaiser, Bruce A.; Polinsky, Martin S.; Palmer, Joanne; Dunn, Stephen P.; Mochon, Manuel; Flynn, Joseph T.; Baluarte, H. Jorge

doi:10.1007/bf00866347

Cited by 22 publications

(8 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In order to minimize this risk, clinicians attempt steroid withdrawal, modify the dose, or prescribe an AD regimen. Most authors admit that long-term AD administration of PN would result in optimal growth and final height after renal transplantation [20,21]. In our study, there was no correlation between growth retardation and the prescription of either D or AD PN treatment, but the study included young patients followed for a short period of time.…”

Section: Discussionmentioning

confidence: 80%

Glucocorticoid pharmacokinetics and growth retardation in children with renal transplants

et al. 2004

View full text Add to dashboard Cite

Long-term glucocorticoid treatment contributes to the growth retardation in children after renal transplantation. We investigated whether determination of prednisone (PN) and prednisolone (PL) in plasma and PN, PL, and 6-beta-hydroxyprednisolone (betaOH-PL) in urine could help to predict growth. PN and PL pharmacokinetics were studied in 36 children, from 5 to 15 years of age, receiving daily (D) or alternate-day (AD) oral PN treatment. Statural growth velocity was evaluated over a 1-year period. We compared three groups of children according to the growth kinetics during the study year (catch-up, stable, or decline) for clinical and pharmacokinetic parameters. A multiple linear regression analysis was performed in order to determine pharmacokinetic parameters able to explain height 1 year after inclusion. Height at the beginning of the study, creatinine clearance, and type of D or AD treatment explained 94.2% of height variance 1 year after inclusion. Only PL clearance was associated with growth evolution, but introduction of PL clearance in the multivariate model did not improve the variance of height accounted for by the previous model. We, therefore, do not recommend using glucocorticoid pharmacokinetics to predict growth retardation in children with renal transplantation.

show abstract

Section: Discussionmentioning

confidence: 80%

Glucocorticoid pharmacokinetics and growth retardation in children with renal transplants

et al. 2004

View full text Add to dashboard Cite

show abstract

“…Such benefit may be partly explained by the fact that the oldest age at the time of transplantation was 16.5 years, which perhaps characterizes the current population as being in "early puberty." However, these data challenge the paradigm that children transplanted between the ages of 13 and 18 years grow poorly or not at all, even with use of alternate-day steroid regimens [17][18][19] or cyclosporine monotherapy [9].…”

Section: Discussionmentioning

confidence: 99%

Growth and renal function after steroid-free tacrolimus-based immunosuppression in children with renal transplants

Ellis

2000

Pediatric Nephrology

View full text Add to dashboard Cite

Steroid withdrawal after renal transplantation and cyclosporine-based immunosuppression enhances growth in children, but this practice is not widely employed because of a 50%-60% rate of rejection, graft dysfunction, or graft loss. The current study evaluates growth and renal function after withdrawal and discontinuation of steroids within 1 year of transplantation in 52 children receiving tacrolimus (FK-506)-based immunosuppression. Height Z-score, weight-for-height index (WHI), and body mass index (BMI), as well as graft loss and calculated creatinine clearance as a measure of glomerular filtration rate (GFR), were assessed. Children were divided into three groups according to age at transplantation: group I, 16 children aged 0-5 years; group II, 17 children aged 6-12 years; group III, 19 children aged 13-16 years. Significant and sustained improvement in height occurred in groups I and III, with Z-scores increasing by 1.51 and 1.57 standard deviations at 3 years after transplantation compared with the Z-score at transplantation (P<0.02). Mean WHI values remained near 100% in groups I and III, and significantly increased above 100% only in group II at 2 years after transplantation. Although actual BMI scores improved significantly in groups II and III at both 2 and 3 years post transplantation (P<0.05), when BMI scores were adjusted for height age, none of these groups had values >95% denoting obesity. Failure of steroid withdrawal, defined as reinstitution of steroids, graft dysfunction, or graft loss, occurred in 9 of 68 (13%) children who underwent steroid withdrawal at any time after transplantation, and resulted in graft dysfunction or graft loss in 5 (7%). Over a 3-year period, rates of renal dysfunction, as manifested by >50% rise in the serum creatinine level above baseline, or graft loss were lower in these 68 children compared with 8 children who never had steroid withdrawal (P<0.05). Mean GFR at 3 years after transplantation ranged from 96 to 102 ml/min per 1.73 m2 in all three steroid withdrawal groups, and remained stable during the 3 years of follow-up. These data indicate that steroid withdrawal enables normalization of growth without obesity, and without imposing an excessive risk for graft dysfunction or graft loss.

show abstract

“…In view of these risks, alternate day steroids might be considered, because improved growth was reported after conversion from a daily to an alternate day regimen (35). In one study, however, conversion was reported to be successful in less than 60% in patients receiving cadaver allografts (36).…”

Section: Discussionmentioning

confidence: 99%

Stimulated cortisol secretion is not correlated with prednisone dose or with steroid side‐effects in children after renal transplantation

Revermann

Soergel

Hellinger

et al. 2002

Pediatric Transplantation

View full text Add to dashboard Cite

Impairment of adrenocortical function and other adverse effects have to be considered whenever corticosteroids are applied for a prolonged period of time. We hypothesized that the assessment of adrenal function with adrenocortiocotropin (ACTH) stimulation reflects the sensitivity to corticosteroids and would predict the development of side-effects in pediatric patients on triple immunosuppression after renal transplantation.

show abstract

Growth after conversion to alternate-day corticosteroids in children with renal transplants: a single-center study

Cited by 22 publications

References 21 publications

Glucocorticoid pharmacokinetics and growth retardation in children with renal transplants

Glucocorticoid pharmacokinetics and growth retardation in children with renal transplants

Growth and renal function after steroid-free tacrolimus-based immunosuppression in children with renal transplants

Stimulated cortisol secretion is not correlated with prednisone dose or with steroid side‐effects in children after renal transplantation

Contact Info

Product

Resources

About