Steroid withdrawal is safe in pediatric kidney recipients

L. Oomen, L.L. de Wall, E.A.M. Cornelissen, W.F.J. Feitz, C.M.H.H.T Bootsma-Robroeks

Wednesday 4 march 2020

16:00 - 16:10h at Theaterzaal

Parallel session: Parallel sessie VI – Klinische abstracts

Background: In the last decades, multiple developments in immunosuppressive therapy for pediatric kidney recipients were seen. Previous literature showed that steroid withdrawal has comparable outcome on graft function and survival as steroid-containing regimens. Less is known about side effects of these regimens. The aim of this study is to establish safety of steroid sparing protocols.

Methods: Data was collected among pediatric kidney transplant recipients during the first five years of follow-up. Use of immunosuppressive medication was documented, as well as infective parameters and other possible side effects of immunosuppressants. Occurrence of side effects was compared between patients remaining on steroids, patients remaining steroid free and those who switched during follow-up.

Results: After introduction of steroid sparing protocols a decline in prednisone use was seen (94% to 43%). Out of 100 recipients, 44 started a steroid-sparing regimen of which 22 remained on during whole follow-up. Reasons to switch medication were mainly gastro-intestinal complaints (23%) and EBV (23%) and BKV (17%) viremia.

Patients remaining on a steroid containing regimens had more UTIs (p=0.012) and worse growth velocity (p=0.035) than those on steroid sparing regimens. Other side effects did not differ between groups.

Conclusions: Steroid sparing immunosuppressive regimes are safe and effective in pediatric kidney recipients.