Long‐term outcome of early steroid withdrawal in pediatric renal transplantation
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 ster...
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| Veröffentlicht in: | Pediatric transplantation 2021-12, Vol.25 (8), p.e14096-n/a |
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| creator | Gajardo, Macarena Delucchi, Angela Pérez, Diego Cancino, José M. Gálvez, Carla Ledezma, Ximena Ceballos, María L. Lillo, Ana M. Cano, Francisco Guerrero, José L. Rojo, Angélica Azócar, Marta González, Gloria Pinilla, Cesar Correa, Ramón Toro, Luis |
| description | 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 |
| doi_str_mv | 10.1111/petr.14096 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2557227412</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2557227412</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3576-f205365fb51fdc039a37206403ebf2fdaa4783c5d62ea343465e5c9850ed99d23</originalsourceid><addsrcrecordid>eNp9kM1Kw0AUhQdRtFY3PoAE3IiQOv9pllL8g4JS6jpMMzc6JcnEmQmlOx_BZ_RJnFp14cKzuZfDx-FwEDoheESiLjsIbkQ4zuUOGhCW5ynDXO5-_VnKCKcH6ND7JcZE8jHfRweMM5pFDdBsatvnj7f3AK5JbB9K20BiqwSUq9eJj7Y1OlmZ8KKdWqk6MW3SgTYqOFMmDtpoBada39WqDSoY2x6hvUrVHo6_7xA93VzPJ3fp9OH2fnI1TUsmMplWFAsmRbUQpNIlZrliGcWSYwaLilZaKZ6NWSm0pKBiYS4FiDIfCww6zzVlQ3S-ze2cfe3Bh6IxvoQ6FgHb-4IKkVGacbJBz_6gS9u72H1D5QLLjHMWqYstVTrrvYOq6JxplFsXBBebpYvN0sXX0hE-_Y7sFw3oX_Rn2giQLbAyNaz_iSoer-ezbegntqmJzA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2595067443</pqid></control><display><type>article</type><title>Long‐term outcome of early steroid withdrawal in pediatric renal transplantation</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><creator>Gajardo, Macarena ; Delucchi, Angela ; Pérez, Diego ; Cancino, José M. ; Gálvez, Carla ; Ledezma, Ximena ; Ceballos, María L. ; Lillo, Ana M. ; Cano, Francisco ; Guerrero, José L. ; Rojo, Angélica ; Azócar, Marta ; González, Gloria ; Pinilla, Cesar ; Correa, Ramón ; Toro, Luis</creator><creatorcontrib>Gajardo, Macarena ; Delucchi, Angela ; Pérez, Diego ; Cancino, José M. ; Gálvez, Carla ; Ledezma, Ximena ; Ceballos, María L. ; Lillo, Ana M. ; Cano, Francisco ; Guerrero, José L. ; Rojo, Angélica ; Azócar, Marta ; González, Gloria ; Pinilla, Cesar ; Correa, Ramón ; Toro, Luis</creatorcontrib><description>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.</description><identifier>ISSN: 1397-3142</identifier><identifier>EISSN: 1399-3046</identifier><identifier>DOI: 10.1111/petr.14096</identifier><identifier>PMID: 34327777</identifier><language>eng</language><publisher>Denmark: Wiley Subscription Services, Inc</publisher><subject>Child ; Death ; Female ; Graft Rejection ; Humans ; Immunosuppressive Agents - therapeutic use ; Kidney transplantation ; Kidney Transplantation - mortality ; Kidney transplants ; long‐term graft survival ; Male ; Medication Adherence ; Mycophenolic acid ; Pediatric renal transplantation ; Pediatrics ; Steroid hormones ; Steroids ; Steroids - administration & dosage ; steroid‐free immunosuppression ; Survival analysis ; Tacrolimus</subject><ispartof>Pediatric transplantation, 2021-12, Vol.25 (8), p.e14096-n/a</ispartof><rights>2021 Wiley Periodicals LLC</rights><rights>2021 Wiley Periodicals LLC.</rights><rights>2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3576-f205365fb51fdc039a37206403ebf2fdaa4783c5d62ea343465e5c9850ed99d23</citedby><cites>FETCH-LOGICAL-c3576-f205365fb51fdc039a37206403ebf2fdaa4783c5d62ea343465e5c9850ed99d23</cites><orcidid>0000-0002-0102-9716 ; 0000-0001-8868-7617</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fpetr.14096$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fpetr.14096$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34327777$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Gajardo, Macarena</creatorcontrib><creatorcontrib>Delucchi, Angela</creatorcontrib><creatorcontrib>Pérez, Diego</creatorcontrib><creatorcontrib>Cancino, José M.</creatorcontrib><creatorcontrib>Gálvez, Carla</creatorcontrib><creatorcontrib>Ledezma, Ximena</creatorcontrib><creatorcontrib>Ceballos, María L.</creatorcontrib><creatorcontrib>Lillo, Ana M.</creatorcontrib><creatorcontrib>Cano, Francisco</creatorcontrib><creatorcontrib>Guerrero, José L.</creatorcontrib><creatorcontrib>Rojo, Angélica</creatorcontrib><creatorcontrib>Azócar, Marta</creatorcontrib><creatorcontrib>González, Gloria</creatorcontrib><creatorcontrib>Pinilla, Cesar</creatorcontrib><creatorcontrib>Correa, Ramón</creatorcontrib><creatorcontrib>Toro, Luis</creatorcontrib><title>Long‐term outcome of early steroid withdrawal in pediatric renal transplantation</title><title>Pediatric transplantation</title><addtitle>Pediatr Transplant</addtitle><description>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.</description><subject>Child</subject><subject>Death</subject><subject>Female</subject><subject>Graft Rejection</subject><subject>Humans</subject><subject>Immunosuppressive Agents - therapeutic use</subject><subject>Kidney transplantation</subject><subject>Kidney Transplantation - mortality</subject><subject>Kidney transplants</subject><subject>long‐term graft survival</subject><subject>Male</subject><subject>Medication Adherence</subject><subject>Mycophenolic acid</subject><subject>Pediatric renal transplantation</subject><subject>Pediatrics</subject><subject>Steroid hormones</subject><subject>Steroids</subject><subject>Steroids - administration & dosage</subject><subject>steroid‐free immunosuppression</subject><subject>Survival analysis</subject><subject>Tacrolimus</subject><issn>1397-3142</issn><issn>1399-3046</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kM1Kw0AUhQdRtFY3PoAE3IiQOv9pllL8g4JS6jpMMzc6JcnEmQmlOx_BZ_RJnFp14cKzuZfDx-FwEDoheESiLjsIbkQ4zuUOGhCW5ynDXO5-_VnKCKcH6ND7JcZE8jHfRweMM5pFDdBsatvnj7f3AK5JbB9K20BiqwSUq9eJj7Y1OlmZ8KKdWqk6MW3SgTYqOFMmDtpoBada39WqDSoY2x6hvUrVHo6_7xA93VzPJ3fp9OH2fnI1TUsmMplWFAsmRbUQpNIlZrliGcWSYwaLilZaKZ6NWSm0pKBiYS4FiDIfCww6zzVlQ3S-ze2cfe3Bh6IxvoQ6FgHb-4IKkVGacbJBz_6gS9u72H1D5QLLjHMWqYstVTrrvYOq6JxplFsXBBebpYvN0sXX0hE-_Y7sFw3oX_Rn2giQLbAyNaz_iSoer-ezbegntqmJzA</recordid><startdate>202112</startdate><enddate>202112</enddate><creator>Gajardo, Macarena</creator><creator>Delucchi, Angela</creator><creator>Pérez, Diego</creator><creator>Cancino, José M.</creator><creator>Gálvez, Carla</creator><creator>Ledezma, Ximena</creator><creator>Ceballos, María L.</creator><creator>Lillo, Ana M.</creator><creator>Cano, Francisco</creator><creator>Guerrero, José L.</creator><creator>Rojo, Angélica</creator><creator>Azócar, Marta</creator><creator>González, Gloria</creator><creator>Pinilla, Cesar</creator><creator>Correa, Ramón</creator><creator>Toro, Luis</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>H94</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-0102-9716</orcidid><orcidid>https://orcid.org/0000-0001-8868-7617</orcidid></search><sort><creationdate>202112</creationdate><title>Long‐term outcome of early steroid withdrawal in pediatric renal transplantation</title><author>Gajardo, Macarena ; Delucchi, Angela ; Pérez, Diego ; Cancino, José M. ; Gálvez, Carla ; Ledezma, Ximena ; Ceballos, María L. ; Lillo, Ana M. ; Cano, Francisco ; Guerrero, José L. ; Rojo, Angélica ; Azócar, Marta ; González, Gloria ; Pinilla, Cesar ; Correa, Ramón ; Toro, Luis</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3576-f205365fb51fdc039a37206403ebf2fdaa4783c5d62ea343465e5c9850ed99d23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Child</topic><topic>Death</topic><topic>Female</topic><topic>Graft Rejection</topic><topic>Humans</topic><topic>Immunosuppressive Agents - therapeutic use</topic><topic>Kidney transplantation</topic><topic>Kidney Transplantation - mortality</topic><topic>Kidney transplants</topic><topic>long‐term graft survival</topic><topic>Male</topic><topic>Medication Adherence</topic><topic>Mycophenolic acid</topic><topic>Pediatric renal transplantation</topic><topic>Pediatrics</topic><topic>Steroid hormones</topic><topic>Steroids</topic><topic>Steroids - administration & dosage</topic><topic>steroid‐free immunosuppression</topic><topic>Survival analysis</topic><topic>Tacrolimus</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Gajardo, Macarena</creatorcontrib><creatorcontrib>Delucchi, Angela</creatorcontrib><creatorcontrib>Pérez, Diego</creatorcontrib><creatorcontrib>Cancino, José M.</creatorcontrib><creatorcontrib>Gálvez, Carla</creatorcontrib><creatorcontrib>Ledezma, Ximena</creatorcontrib><creatorcontrib>Ceballos, María L.</creatorcontrib><creatorcontrib>Lillo, Ana M.</creatorcontrib><creatorcontrib>Cano, Francisco</creatorcontrib><creatorcontrib>Guerrero, José L.</creatorcontrib><creatorcontrib>Rojo, Angélica</creatorcontrib><creatorcontrib>Azócar, Marta</creatorcontrib><creatorcontrib>González, Gloria</creatorcontrib><creatorcontrib>Pinilla, Cesar</creatorcontrib><creatorcontrib>Correa, Ramón</creatorcontrib><creatorcontrib>Toro, Luis</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Pediatric transplantation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Gajardo, Macarena</au><au>Delucchi, Angela</au><au>Pérez, Diego</au><au>Cancino, José M.</au><au>Gálvez, Carla</au><au>Ledezma, Ximena</au><au>Ceballos, María L.</au><au>Lillo, Ana M.</au><au>Cano, Francisco</au><au>Guerrero, José L.</au><au>Rojo, Angélica</au><au>Azócar, Marta</au><au>González, Gloria</au><au>Pinilla, Cesar</au><au>Correa, Ramón</au><au>Toro, Luis</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Long‐term outcome of early steroid withdrawal in pediatric renal transplantation</atitle><jtitle>Pediatric transplantation</jtitle><addtitle>Pediatr Transplant</addtitle><date>2021-12</date><risdate>2021</risdate><volume>25</volume><issue>8</issue><spage>e14096</spage><epage>n/a</epage><pages>e14096-n/a</pages><issn>1397-3142</issn><eissn>1399-3046</eissn><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.</abstract><cop>Denmark</cop><pub>Wiley Subscription Services, Inc</pub><pmid>34327777</pmid><doi>10.1111/petr.14096</doi><tpages>0</tpages><orcidid>https://orcid.org/0000-0002-0102-9716</orcidid><orcidid>https://orcid.org/0000-0001-8868-7617</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1397-3142 |
| ispartof | Pediatric transplantation, 2021-12, Vol.25 (8), p.e14096-n/a |
| issn | 1397-3142 1399-3046 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2557227412 |
| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | Child Death Female Graft Rejection Humans Immunosuppressive Agents - therapeutic use Kidney transplantation Kidney Transplantation - mortality Kidney transplants long‐term graft survival Male Medication Adherence Mycophenolic acid Pediatric renal transplantation Pediatrics Steroid hormones Steroids Steroids - administration & dosage steroid‐free immunosuppression Survival analysis Tacrolimus |
| title | Long‐term outcome of early steroid withdrawal in pediatric renal transplantation |
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