A steroid-free approach to immunosuppression following pediatric renal transplants is safe and effective, according to a study published online in the American Journal of Transplantation.
Minnie M. Sarwala, MD, PhD, of the California Pacific Medical Center in San Francisco, and associates conducted a randomized multicenter study involving 130 children receiving primary kidney transplants between 2004 and 2006. Participants were randomly allocated to steroid-free (SF) or steroid-based (SB) immunosuppression, together with tacrolimus, mycophenolate, and standard or extended-dose daclizumab (SB and SF groups, respectively).
After three years of follow-up the researchers found that the standardized height Z-score change was −0.99 for SF patients, compared with −0.93 in SB patients, a nonsignificant difference. At three years, recipients younger than five years showed significantly improved linear growth with SF versus SB treatment (−0.43 vs. −1.07). The rates of biopsy-proven acute rejection at three years post-transplant were similar in both groups (16.7 in SF vs.17.1 in SB). Patient survival was 100% in both groups, with graft survival of 95% and 90% in the SF and SB groups, respectively. The SF group showed significantly lower systolic blood pressure and lower cholesterol levels than the SB group.
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“In conclusion, complete steroid avoidance, combined with effective induction, tacrolimus and mycophenolate mofetil, provides a new therapeutic standard for safe and effective immunosuppression for renal transplantation of low-risk children with end-stage renal disease,” the authors wrote.
The study was funded by Astellas and Roche Pharmaceuticals.
