A prospective trial of steroid withdrawal after renal transplantation treated with cyclosporine and mizoribine in children: Results obtained between 1990 and 2003

Abstract: A prospective trial of adrenocorticostertoid (steroid) withdrawal after pediatric renal transplantation was begun in 1990. Ninety‐four pediatric renal transplant recipients were enrolled in our multicenter study. Immunosuppressive therapy with cyclosporine (CyA), methylprednisolone (MPL), and mizoribine (MZ) was started after transplantation. MPL was reduced to administration on alternate days in 69 patients (73.4%) and was withdrawn in 27 patients (28.7%). Rejection episodes occurred in nine patients (33.3%) after withdrawal of MPL. It occurred within 3 months after withdrawal of MPL in two patients and more than 6 months in the others. Among them, two patients lost the grafts. Thirteen‐year patient survival rate and graft survival rate were 94.6 and 83.1%, respectively. Forty‐four of the 94 patients reached their final height. Mean final height was 155.0 cm in males and 146.3 cm in females and their height standard deviation score was −2.6 s.d., the same as that at the time of transplantation. Management of growth retardation before transplantation and further reduction in the steroid dose after transplantation will increase the final height of children with chronic renal failure.

[1]  G. Becker,et al.  Triple immunosuppression with subsequent prednisolone withdrawal: 6 years' experience in paediatric renal allograft recipients , 1994, Pediatric Nephrology.

[2]  Minnie M Sarwal,et al.  Continued superior outcomes with modification and lengthened follow-up of a steroid-avoidance pilot with extended daclizumab induction in pediatric renal transplantation1 , 2003, Transplantation.

[3]  T. Starzl,et al.  OUTCOME AFTER STEROID WITHDRAWAL IN PEDIATRIC RENAL TRANSPLANT PATIENTS RECEIVING TACROLIMUS-BASED IMMUNOSUPPRESSION1 , 1999, Transplantation.

[4]  J. Ehrich,et al.  Kidney transplanted children come of age. , 1999, Kidney international.

[5]  H. E. Hansen,et al.  The Banff 97 working classification of renal allograft pathology. , 1999, Kidney international.

[6]  S. Kelley,et al.  Pediatric solid organ transplantation. , 1998, Current opinion in anaesthesiology.

[7]  M. Hattori,et al.  A prospective trial of steroid cessation after renal transplantation in pediatric patients treated with cyclosporine and mizoribine. , 1997, Pediatric transplantation.

[8]  T. Stijnen,et al.  Final Height and Its Predictive Factors after Renal Transplantation in Childhood , 1994, Pediatric Research.

[9]  D. Hricik,et al.  Steroid withdrawal after renal transplantation. , 1994, Clinical transplantation.

[10]  L. Rees.  Growth post transplantation in children: steroids and growth inhibition. , 1994 .

[11]  M. Suthanthiran,et al.  Steroid withdrawal, rejection and the mixed lymphocyte reaction in children after renal transplantation. , 1993, Kidney international. Supplement.

[12]  M. Murata.  Japanese Specific Bone Age Standard on the TW2 , 1993 .

[13]  A. Edefonti,et al.  ADVANTAGES OF CYCLOSPORINE AS SOLE IMMUNOSUPPRESSIVE AGENT IN CHILDREN WITH TRANSPLANTED KIDNEYS , 1992, Transplantation.

[14]  K. Tachibana,et al.  Longitudinal Standards for Height and Height Velocity for Japanese Children from Birth to Maturity , 1992 .

[15]  D. Abendroth,et al.  Remarkable long-term prognosis and excellent growth in kidney-transplant children under cyclosporine monotherapy. , 1991, Transplantation proceedings.

[16]  P. Hoyer,et al.  Adult height achieved in children after kidney transplantation. , 1990, American journal of diseases of children.

[17]  H. Schanzer,et al.  Follow-up of cyclosporine-treated pediatric renal allograft recipients after cessation of prednisone. , 1990, Transplantation.

[18]  A. Sheil,et al.  Cyclosporin A as sole immunosuppressive agent for renal transplantation in children: effect on catch-up growth. , 1989, Transplantation proceedings.

[19]  M. Preece,et al.  Growth and endocrine function after renal transplantation. , 1988, Archives of disease in childhood.

[20]  L. Brion,et al.  The use of plasma creatinine concentration for estimating glomerular filtration rate in infants, children, and adolescents. , 1987, Pediatric clinics of North America.

[21]  M. Khawar,et al.  Cyclosporine experience in renal transplantation in children. , 1986, The Mount Sinai journal of medicine, New York.

[22]  N. Barnes.  Atlas of children's growth. Normal variation and growth disorders , 1983 .

[23]  M. Okudaira,et al.  Effectiveness of a new drug, bredinin, on canine kidney allotransplant survival. , 1979, Transplantation proceedings.

[24]  R. Fine,et al.  Growth in children following renal transplantation. , 1973, American journal of diseases of children.