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Li L, Chang A, Naesens M, Kambham N, Waskerwitz J, Martin J, Wong C, Alexander S, Grimm P, Concepcion W, Salvatierra O, Sarwal M. Steroid-free immunosuppression since 1999: 129 pediatric renal transplants with sustained graft and patient benefits. Am J Transplant 2009; 9:1362-72. [PMID: 19459814 PMCID: PMC2724986 DOI: 10.1111/j.1600-6143.2009.02640.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Despite early promising patient and graft outcomes with steroid-free (SF) immunosuppression in pediatric kidney transplant recipients, data on long-term safety and efficacy results are lacking. We present our single-center experience with 129 consecutive pediatric kidney transplant recipients on SF immunosuppression, with a mean follow-up of 5 years. Outcomes are compared against a matched cohort of 57 concurrent recipients treated with steroid-based (SB) immunosuppression. In the SF group, 87% of kidney recipients with functioning grafts remain corticosteroid-free. Actual intent-to-treat SF (ITT-SF) and still-on-protocol SF patient survivals are 96% and 96%, respectively, actual graft survivals for both groups are 93% and 96%, respectively and actual death-censored graft survivals for both groups are 97% and 99%, respectively. Unprecedented catch-up growth is observed in SF recipients below 12 years of age. Continued low rates of acute rejection, posttransplant diabetes mellitus (PTDM), hypertension and hyperlipidemia are seen in SF patients, with sustained benefits for graft function. In conclusion, extended enrollment and longer experience with SF immunosuppression for renal transplantation in low-risk children confirms protocol safety, continued benefits for growth and graft function, low acute rejection rates and reduced cardiovascular morbidity.
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Affiliation(s)
- L. Li
- Dept. of Pediatrics, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - A. Chang
- Dept. of Pediatrics, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - M. Naesens
- Dept. of Pediatrics, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - N. Kambham
- Dept. of Pathology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - J. Waskerwitz
- Dept. of Pediatrics, Stanford University School of Medicine, Stanford, CA 94305, USA,Dept. of Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - J. Martin
- Dept. of Pediatrics, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - C. Wong
- Dept. of Pediatrics, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - S. Alexander
- Dept. of Pediatrics, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - P. Grimm
- Dept. of Pediatrics, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - W. Concepcion
- Dept. of Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - O. Salvatierra
- Dept. of Pediatrics, Stanford University School of Medicine, Stanford, CA 94305, USA,Dept. of Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA,Corresponding Authors: Minnie Sarwal, MD, MRCP, Ph.D., G306, 300 Pasteur Drive, Stanford University School of Medicine, Stanford, CA 94305 USA, , Phone: (650)723-4517, Fax: (650)498-6762, Salvatierra Oscar, MD., 703 Welch Rd., H2, Stanford University School of Medicine, Stanford, CA 94305 USA, , Phone: (650)498-5481
| | - M.M. Sarwal
- Dept. of Pediatrics, Stanford University School of Medicine, Stanford, CA 94305, USA,Corresponding Authors: Minnie Sarwal, MD, MRCP, Ph.D., G306, 300 Pasteur Drive, Stanford University School of Medicine, Stanford, CA 94305 USA, , Phone: (650)723-4517, Fax: (650)498-6762, Salvatierra Oscar, MD., 703 Welch Rd., H2, Stanford University School of Medicine, Stanford, CA 94305 USA, , Phone: (650)498-5481
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