Improved growth and cardiovascular risk after late steroid withdrawal: 2-year results of a prospective, randomised trial in paediatric renal transplantation

Abstract

Late steroid withdrawal in selected CsA- and MMF-treated paediatric kidney transplant recipients improves growth, mitigates cardiovascular risk factors and reduces the prevalence of the metabolic syndrome, at no increased risk of acute rejection or unstable graft function.

Growth hormone treatment after renal transplantation: a promising but underused chance to improve growth

“…This is reported especially for young children, who are known to have the best growth rates even with corticosteroid-based treatment regiments. In the multicenter study of Sarwal et al [3], the subgroup of recipients <5 years of age showed improvement in height SDS (1.07 ± 1.14 within 3 years) with complete avoidance of corticosteroids when compared with patients on steroid-based treatment (0.43 ± 1.15). Late selective withdrawal of corticosteroids in the randomized study of Höcker et al [2] improved height SDS by +0.6 ± 0.1 within 2 years compared with −0.2 ± 0.1 in controls.…”

“…Complete avoidance [3] or selective withdrawal [2] of corticosteroids leads without doubt to significant improvement in growth. This is reported especially for young children, who are known to have the best growth rates even with corticosteroid-based treatment regiments.…”

“…One must keep in mind that so far, growth and renal function were observed only in the short to medium term. In most steroid withdrawal studies, the immunosuppressive regiments compensate for steroid withdrawal by increasing target levels of calcineurin inhibitors or by adding other drugs (for instance, antibodies such as daclizumab) [3]. Future long-term studies must show whether or not renal function is negatively influenced by the new immunosuppressive regiments.…”

“…Fear of rejection episodes has prevented regular use of GH in transplanted children during the last two decades. At the same time, steroid withdrawal [2] or even steroid-free immunosuppression [3] became a popular new strategy to improve growth after TPL. This raises the question of whether GH treatment is needed at all in transplanted children.…”

Paediatric obesity and renal transplantation: current challenges and solutions

“…It is unsurprising, therefore, to see that the prevalence of the metabolic syndrome in children increases following transplantation, affecting between 20 and 40 % of individuals in the first 1-2 years post-transplantation, particularly with prolonged corticosteroid use [50,51]. It is obesity and its influence on the development of the cardiovascular risk factors comprising the metabolic syndrome that are the central components of the elevated incidence of cardiovascular mortality in paediatric renal transplantation.…”