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Steroid avoidance using sirolimus and cyclosporine in pediatric renal transplantation: One year analysis
Author(s) -
Iorember Franca M.,
Patel Hiren P.,
Ohana Alison,
Hayes John R.,
Mahan John D.,
Baker Peter B.,
Rajab Amer
Publication year - 2010
Publication title -
pediatric transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.457
H-Index - 69
eISSN - 1399-3046
pISSN - 1397-3142
DOI - 10.1111/j.1399-3046.2009.01135.x
Subject(s) - medicine , sirolimus , transplantation , renal transplant , urology , kidney transplantation , steroid , hormone
Iorember FM, Patel HP, Ohana A, Hayes JR, Mahan JD, Baker PB, Rajab A. Steroid avoidance using sirolimus and cyclosporine in pediatric renal transplantation: One year analysis.
Pediatr Transplantation 2010: 14: 93–99. © 2009 John Wiley & Sons A/S. Abstract: Steroids are commonly used in pediatric renal transplantation, but have numerous adverse effects. This retrospective study compares one‐yr outcomes in 22 pediatric renal transplant recipients receiving SRL and CSA as primary immunosuppression (steroid‐avoidance group) to age‐ and gender‐matched historical controls receiving CSA, MMF, and prednisone (steroid group). At one yr, both groups had similar graft survival, acute rejection, and estimated GFR. Subjects in the steroid‐avoidance group had better linear growth, less excessive weight gain and were less likely to have an increase in antihypertensive medication use. Subjects in the steroid‐avoidance group were more likely to be started on lipid lowering medications and erythropoiesis stimulating agents. Despite having a greater proportion of living donors, the steroid‐avoidance group had a similar GFR compared to the steroid group at one month. The steroid‐avoidance group was also more likely to have a biopsy for elevated Cr that was not because of rejection and had more interstitial fibrosis noted. We conclude that using a steroid‐avoidance immunosuppression regimen of SRL and CSA results in comparable rejection rates and short‐term graft function with less steroid‐associated morbidity. However, early findings also suggest possible potentiation of CSA nephrotoxicity by SRL in some children.