Steroid Withdrawal in Pediatric Kidney Recipients: Is it Safe?

Introduction: In the last decades, immunosuppressive therapy for pediatric kidney recipients has changed dramatically. Early steroid withdrawal, being one of these, has shown comparable outcomes on graft function and survival compared to steroid- based regimens. Less is known about the possible negative effects of this regimen. The aim of this study was to evaluate the safety of the steroid-sparing TWIST regimen in pediatric kidney recipients. Design: Data were collected among pediatric kidney transplant recipients during the first five years of follow-up in a single center. Documented data included immunosuppressive protocols, infections, hypertension, diabetes, anemia, leucopenia, candiduria, growth retardation, gastrointestinal complaints, nephrotoxicity, lymphoma and rejection. Occurrence of these effects was compared between patients that started on a steroid-sparing regimen and those starting on a steroid-containing regimen using an intention to treat analysis with censoring at the moment of switching. Results: Out of 100 recipients, 44 patients started the steroid-sparing regimen immediately after transplant surgery. Twenty (45%) of these remained on this regimen during whole follow-up period. Patients on a steroid-based regimen had significantly more urinary tract infections, cmv infections and rejections than those on a steroid-sparing regimen. Other side effects did not differ between the groups. Conclusion: Steroid-sparing immunosuppressive therapy regimen is preferable and safe in pediatric kidney transplant recipients without additional potential risk factors and is accompanied with less opportunistic infections.