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Observational Study
. 2021 Dec;25(8):e14096.
doi: 10.1111/petr.14096. Epub 2021 Jul 29.

Long-term outcome of early steroid withdrawal in pediatric renal transplantation

Macarena Gajardo  1   2   3 , Angela Delucchi  1   2   4 , Diego Pérez  5 , José M Cancino  6 , Carla Gálvez  1 , Ximena Ledezma  1 , María L Ceballos  1   2 , Ana M Lillo  1 , Francisco Cano  1   2 , José L Guerrero  1 , Angélica Rojo  1 , Marta Azócar  1   2 , Gloria González  7 , Cesar Pinilla  7 , Ramón Correa  7 , Luis Toro  8   9   10
Affiliations
Observational Study

Long-term outcome of early steroid withdrawal in pediatric renal transplantation

Macarena Gajardo et al. Pediatr Transplant. 2021 Dec.

Abstract

Background: Steroid use in renal transplant is related to multiple adverse effects. Long-term effects of early withdrawal steroids in pediatric renal transplant were assessed.

Methods: Renal transplant children with low immunological risk treated on basiliximab, tacrolimus, and mycophenolate with steroid withdrawal or steroid control were evaluated between 2003 and 2019. Clinical variables, treatment adherence, acute rejection, graft loss, and death were analyzed through hazard ratios, and Kaplan-Meier and multivariate analyses.

Results: The study included 152 patients, 71.1% steroid withdrawal, mean follow-up 8.5 years, 64.5% structural abnormalities, and 81.6% deceased donor. At 12 years of transplant, event-free survival analysis for graft loss or death showed no significant difference between steroid withdrawal and control steroid treatment (85.9% vs. 80.4%, p = .36) nor in acute rejection at 10 years (18.5% vs. 20.5%, p = .78) or in donor-specific antibody appearance (19.6% vs. 21.4%, p = .98). Delta height Z-score was increased in the steroid withdrawal group (p < .01). The main predictor of graft loss or death was non-adherence to treatment (p = .001; OR: 17.5 [3.3-90.9]).

Conclusions: Steroid withdrawal therapy was effective and safe for low-risk pediatric renal transplant in long-term evaluation. Non-adherence was the main predictor of graft loss or death.

Keywords: Pediatric renal transplantation; long-term graft survival; steroid-free immunosuppression.

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References

REFERENCES

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