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Review
. 2022 Mar;26(2):e14189.
doi: 10.1111/petr.14189. Epub 2021 Nov 17.

Steroid avoidance/withdrawal and maintenance immunosuppression in pediatric kidney transplantation

Sarah J Kizilbash  1 , Chelsey J Jensen  2 , Anne M Kouri  1 , Shanthi S Balani  1 , Blanche Chavers  1
Affiliations
Review

Steroid avoidance/withdrawal and maintenance immunosuppression in pediatric kidney transplantation

Sarah J Kizilbash et al. Pediatr Transplant. 2022 Mar.

Abstract

Background: Corticosteroids have been an integral part of maintenance immunosuppression for pediatric kidney transplantation. However, prolonged steroid therapy is associated with significant toxicities resulting in several SW/avoidance strategies in recent years.

Method/objective: This comprehensive review aims to discuss steroid-related toxicities and the safety, efficacy, and benefit of steroid avoidance/withdrawal immunosuppression in pediatric kidney transplant recipients.

Results: Initial studies of SW/avoidance conducted in the setting of CSA and AZA showed an increased incidence of AR but no increase in graft loss or mortality with SW/avoidance maintenance immunosuppression. Studies performed under modern immunosuppression (induction therapy, Tac, and MMF) show no significant increase in AR or graft loss with SW/avoidance immunosuppression. Furthermore, SW/avoidance immunosuppression is associated with significant improvement in growth, BMI, BP control, and lipid profile in pediatric kidney transplant recipients. Despite these data, SW/avoidance remains controversial, and only 40% of pediatric kidney transplant recipients in the United States are currently on SW/avoidance maintenance immunosuppression.

Conclusion: SW/avoidance maintenance immunosuppression is safe and associated with fewer side effects compared with steroid-inclusive maintenance immunosuppression in pediatric kidney transplant recipients.

Keywords: immunosuppression; kidney transplant; pediatric; steroid avoidance; steroid withdrawal.

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References

REFERENCES

    1. Papalois VE, Najarian JS. Pediatric kidney transplantation: historic hallmarks and a personal perspective. Pediatr Transplant. 2001;5:239-245.
    1. Liu D, Ahmet A, Ward L, et al. A practical guide to the monitoring and management of the complications of systemic corticosteroid therapy. Allergy Asthma Clin Immunol. 2013;9:30.
    1. Rhen T, Cidlowski JA. Antiinflammatory action of glucocorticoids-new mechanisms for old drugs. New Engl J Med. 2005;353:1711-1723.
    1. Curtis JR, Westfall AO, Allison J, et al. Population-based assessment of adverse events associated with long-term glucocorticoid use. Arthritis Rheum. 2006;55:420-426.
    1. Wesseling-Perry K, Bacchetta J. CKD-MBD after kidney transplantation. Pediatr Nephrol. 2011;26:2143-2151.

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