Steroid‐Free Immunosuppression Since 1999: 129 Pediatric Renal Transplants with Sustained Graft and Patient Benefits
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...
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| Veröffentlicht in: | American journal of transplantation 2009-06, Vol.9 (6), p.1362-1372 |
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| creator | Li, L. Chang, A. Naesens, M. Kambham, N. Waskerwitz, J. Martin, J. Wong, C. Alexander, S. Grimm, P. Concepcion, W. Salvatierra, O. Sarwal, M. M. |
| description | 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.
Steroid Avoidance in children is a safe choice for renal transplantation, as it offers good transplant outcomes, restores normal growth patterns and mitigates cardiovascular morbidities. |
| doi_str_mv | 10.1111/j.1600-6143.2009.02640.x |
| format | Article |
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Steroid Avoidance in children is a safe choice for renal transplantation, as it offers good transplant outcomes, restores normal growth patterns and mitigates cardiovascular morbidities.</description><identifier>ISSN: 1600-6135</identifier><identifier>EISSN: 1600-6143</identifier><identifier>DOI: 10.1111/j.1600-6143.2009.02640.x</identifier><identifier>PMID: 19459814</identifier><language>eng</language><publisher>Malden, USA: Blackwell Publishing Inc</publisher><subject>Adolescent ; Adrenal Cortex Hormones - therapeutic use ; Biological and medical sciences ; Child ; Child, Preschool ; Female ; Fundamental and applied biological sciences. Psychology ; Fundamental immunology ; General aspects ; Graft Rejection - immunology ; Graft Survival - immunology ; Humans ; Hypercholesterolemia - etiology ; Hypertension - etiology ; Hypertriglyceridemia - etiology ; Immunosuppression Therapy - methods ; Immunosuppressive Agents - immunology ; Kaplan-Meier Estimate ; Kidney transplantation ; Kidney Transplantation - adverse effects ; Kidney Transplantation - immunology ; Kidney Transplantation - mortality ; Male ; Medical sciences ; pediatrics ; steroid‐free ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surgery of the urinary system ; Tissue, organ and graft immunology</subject><ispartof>American journal of transplantation, 2009-06, Vol.9 (6), p.1362-1372</ispartof><rights>2009 The Authors Journal compilation © 2009 The American Society of Transplantation and the American Society of Transplant Surgeons</rights><rights>2009 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5340-68edc7bda75bf65e47c2353050c2c9dda6d01449420421fe38d785508c01d1933</citedby><cites>FETCH-LOGICAL-c5340-68edc7bda75bf65e47c2353050c2c9dda6d01449420421fe38d785508c01d1933</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fj.1600-6143.2009.02640.x$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fj.1600-6143.2009.02640.x$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>230,314,780,784,885,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=21662745$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19459814$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Li, L.</creatorcontrib><creatorcontrib>Chang, A.</creatorcontrib><creatorcontrib>Naesens, M.</creatorcontrib><creatorcontrib>Kambham, N.</creatorcontrib><creatorcontrib>Waskerwitz, J.</creatorcontrib><creatorcontrib>Martin, J.</creatorcontrib><creatorcontrib>Wong, C.</creatorcontrib><creatorcontrib>Alexander, S.</creatorcontrib><creatorcontrib>Grimm, P.</creatorcontrib><creatorcontrib>Concepcion, W.</creatorcontrib><creatorcontrib>Salvatierra, O.</creatorcontrib><creatorcontrib>Sarwal, M. M.</creatorcontrib><title>Steroid‐Free Immunosuppression Since 1999: 129 Pediatric Renal Transplants with Sustained Graft and Patient Benefits</title><title>American journal of transplantation</title><addtitle>Am J Transplant</addtitle><description>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.
Steroid Avoidance in children is a safe choice for renal transplantation, as it offers good transplant outcomes, restores normal growth patterns and mitigates cardiovascular morbidities.</description><subject>Adolescent</subject><subject>Adrenal Cortex Hormones - therapeutic use</subject><subject>Biological and medical sciences</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Female</subject><subject>Fundamental and applied biological sciences. Psychology</subject><subject>Fundamental immunology</subject><subject>General aspects</subject><subject>Graft Rejection - immunology</subject><subject>Graft Survival - immunology</subject><subject>Humans</subject><subject>Hypercholesterolemia - etiology</subject><subject>Hypertension - etiology</subject><subject>Hypertriglyceridemia - etiology</subject><subject>Immunosuppression Therapy - methods</subject><subject>Immunosuppressive Agents - immunology</subject><subject>Kaplan-Meier Estimate</subject><subject>Kidney transplantation</subject><subject>Kidney Transplantation - adverse effects</subject><subject>Kidney Transplantation - immunology</subject><subject>Kidney Transplantation - mortality</subject><subject>Male</subject><subject>Medical sciences</subject><subject>pediatrics</subject><subject>steroid‐free</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Surgery of the urinary system</subject><subject>Tissue, organ and graft immunology</subject><issn>1600-6135</issn><issn>1600-6143</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkc1u1DAQxyMEoqXwCsgX4LTBX0lsJJBKRUtRJSp2OVtee0K9SpxgO_248Qg8I0-Cw64WuCB88Ujzm79m9CsKRHBJ8nu5KUmN8aImnJUUY1liWnNc3t4rDveN-_uaVQfFoxg3GJOGCvqwOCCSV1IQflhcLxOEwdkf376fBgB03veTH-I0jgFidINHS-cNICKlfIUIlegSrNMpOIM-gdcdWgXt49hpnyK6cekKLaeYtPNg0VnQbULaW3SpkwOf0Fvw0LoUHxcPWt1FeLL7j4rPp-9WJ-8XFx_Pzk-OLxamYjzvLsCaZm11U63bugLeGMoqhitsqJHW6tpiwrnkFHNKWmDCNqKqsDCYWCIZOyrebHPHad3nrLxD0J0ag-t1uFODdurvjndX6stwrWhDuRR1DnixCwjD1wliUr2LBrp8LwxTVA1jhGFJmkw-_ydJcS0EIXOk2IImDDEGaPfrEKxmvWqjZnNqtqhmveqXXnWbR5_-ec7vwZ3PDDzbAToa3bXZjXFxz1FS17ThVeZeb7kb18Hdfy-gjj-s5or9BJtqwbM</recordid><startdate>200906</startdate><enddate>200906</enddate><creator>Li, L.</creator><creator>Chang, A.</creator><creator>Naesens, M.</creator><creator>Kambham, N.</creator><creator>Waskerwitz, J.</creator><creator>Martin, J.</creator><creator>Wong, C.</creator><creator>Alexander, S.</creator><creator>Grimm, P.</creator><creator>Concepcion, W.</creator><creator>Salvatierra, O.</creator><creator>Sarwal, M. 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Psychology</topic><topic>Fundamental immunology</topic><topic>General aspects</topic><topic>Graft Rejection - immunology</topic><topic>Graft Survival - immunology</topic><topic>Humans</topic><topic>Hypercholesterolemia - etiology</topic><topic>Hypertension - etiology</topic><topic>Hypertriglyceridemia - etiology</topic><topic>Immunosuppression Therapy - methods</topic><topic>Immunosuppressive Agents - immunology</topic><topic>Kaplan-Meier Estimate</topic><topic>Kidney transplantation</topic><topic>Kidney Transplantation - adverse effects</topic><topic>Kidney Transplantation - immunology</topic><topic>Kidney Transplantation - mortality</topic><topic>Male</topic><topic>Medical sciences</topic><topic>pediatrics</topic><topic>steroid‐free</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Surgery of the urinary system</topic><topic>Tissue, organ and graft immunology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Li, L.</creatorcontrib><creatorcontrib>Chang, A.</creatorcontrib><creatorcontrib>Naesens, M.</creatorcontrib><creatorcontrib>Kambham, N.</creatorcontrib><creatorcontrib>Waskerwitz, J.</creatorcontrib><creatorcontrib>Martin, J.</creatorcontrib><creatorcontrib>Wong, C.</creatorcontrib><creatorcontrib>Alexander, S.</creatorcontrib><creatorcontrib>Grimm, P.</creatorcontrib><creatorcontrib>Concepcion, W.</creatorcontrib><creatorcontrib>Salvatierra, O.</creatorcontrib><creatorcontrib>Sarwal, M. M.</creatorcontrib><collection>Pascal-Francis</collection><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>Risk Abstracts</collection><collection>Safety Science and Risk</collection><collection>Environmental Sciences and Pollution Management</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>American journal of transplantation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Li, L.</au><au>Chang, A.</au><au>Naesens, M.</au><au>Kambham, N.</au><au>Waskerwitz, J.</au><au>Martin, J.</au><au>Wong, C.</au><au>Alexander, S.</au><au>Grimm, P.</au><au>Concepcion, W.</au><au>Salvatierra, O.</au><au>Sarwal, M. M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Steroid‐Free Immunosuppression Since 1999: 129 Pediatric Renal Transplants with Sustained Graft and Patient Benefits</atitle><jtitle>American journal of transplantation</jtitle><addtitle>Am J Transplant</addtitle><date>2009-06</date><risdate>2009</risdate><volume>9</volume><issue>6</issue><spage>1362</spage><epage>1372</epage><pages>1362-1372</pages><issn>1600-6135</issn><eissn>1600-6143</eissn><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.
Steroid Avoidance in children is a safe choice for renal transplantation, as it offers good transplant outcomes, restores normal growth patterns and mitigates cardiovascular morbidities.</abstract><cop>Malden, USA</cop><pub>Blackwell Publishing Inc</pub><pmid>19459814</pmid><doi>10.1111/j.1600-6143.2009.02640.x</doi><tpages>11</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
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| ispartof | American journal of transplantation, 2009-06, Vol.9 (6), p.1362-1372 |
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| source | MEDLINE; Access via Wiley Online Library; EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| subjects | Adolescent Adrenal Cortex Hormones - therapeutic use Biological and medical sciences Child Child, Preschool Female Fundamental and applied biological sciences. Psychology Fundamental immunology General aspects Graft Rejection - immunology Graft Survival - immunology Humans Hypercholesterolemia - etiology Hypertension - etiology Hypertriglyceridemia - etiology Immunosuppression Therapy - methods Immunosuppressive Agents - immunology Kaplan-Meier Estimate Kidney transplantation Kidney Transplantation - adverse effects Kidney Transplantation - immunology Kidney Transplantation - mortality Male Medical sciences pediatrics steroid‐free Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the urinary system Tissue, organ and graft immunology |
| title | Steroid‐Free Immunosuppression Since 1999: 129 Pediatric Renal Transplants with Sustained Graft and Patient Benefits |
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