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Gajardo M, Delucchi A, Pérez D, Cancino JM, Gálvez C, Ledezma X, Ceballos ML, Lillo AM, Cano F, Guerrero JL, Rojo A, Azócar M, González G, Pinilla C, Correa R, Toro L. Long-term outcome of early steroid withdrawal in pediatric renal transplantation. Pediatr Transplant 2021; 25:e14096. [PMID: 34327777 DOI: 10.1111/petr.14096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 06/15/2021] [Accepted: 07/08/2021] [Indexed: 01/29/2023]
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.
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Affiliation(s)
- Macarena Gajardo
- Division of Nephrology, Hospital Luis Calvo Mackenna, Santiago, Chile.,University of Chile, Santiago, Chile.,Division of Nephrology, Hospital Roberto del Río, Santiago, Chile
| | - Angela Delucchi
- Division of Nephrology, Hospital Luis Calvo Mackenna, Santiago, Chile.,University of Chile, Santiago, Chile.,Division of Nephrology, Clínica Alemana, Santiago, Chile
| | - Diego Pérez
- Department of Pediatric, Hospital Luis Calvo Mackenna, Santiago, Chile
| | - José M Cancino
- Division of Nephrology, Hospital del Salvador, Santiago, Chile
| | - Carla Gálvez
- Division of Nephrology, Hospital Luis Calvo Mackenna, Santiago, Chile
| | - Ximena Ledezma
- Division of Nephrology, Hospital Luis Calvo Mackenna, Santiago, Chile
| | - María L Ceballos
- Division of Nephrology, Hospital Luis Calvo Mackenna, Santiago, Chile.,University of Chile, Santiago, Chile
| | - Ana M Lillo
- Division of Nephrology, Hospital Luis Calvo Mackenna, Santiago, Chile
| | - Francisco Cano
- Division of Nephrology, Hospital Luis Calvo Mackenna, Santiago, Chile.,University of Chile, Santiago, Chile
| | - José L Guerrero
- Division of Nephrology, Hospital Luis Calvo Mackenna, Santiago, Chile
| | - Angélica Rojo
- Division of Nephrology, Hospital Luis Calvo Mackenna, Santiago, Chile
| | - Marta Azócar
- Division of Nephrology, Hospital Luis Calvo Mackenna, Santiago, Chile.,University of Chile, Santiago, Chile
| | - Gloria González
- Renal transplant program, Hospital Luis Calvo Mackenna, Santiago, Chile
| | - Cesar Pinilla
- Renal transplant program, Hospital Luis Calvo Mackenna, Santiago, Chile
| | - Ramón Correa
- Renal transplant program, Hospital Luis Calvo Mackenna, Santiago, Chile
| | - Luis Toro
- Division of Nephrology, Department of Medicine, Hospital Clinico Universidad de Chile, Santiago, Chile.,Centro de Investigación Clínica Avanzada, Hospital Clinico Universidad de Chile, Santiago, Chile.,Critical Care Center, Clínica Las Condes, Santiago, Chile
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