Retiro precoz de esteroides en la inmunosupresión del trasplante renal pediátrico

Background: Cardiovascular risk, growth failure and the new immunosuppressive drugs, have encouraged steroid withdrawal or total avoidance with promising results in renal transplant (Tx) immunosuppression. Aim: To evaluate a new immunosuppressor protocol with early withdrawal of steroids in pediatri...

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Autores principales:	Delucchi B,Angela, Valenzuela A,Marcela, Ferrario B,Mario, Lillo D,Ana María, Guerrero G,José Luis, Rodríguez S,Eugenio, Cano Sch,Francisco, Cavada Ch,Gabriel, Godoy L,Jorge, Rodríguez H,Jorge, González G,Gloria, Buckel B,Erwin, Contreras M,Luis
Lenguaje:	Spanish / Castilian
Publicado:	Sociedad Médica de Santiago 2006
Materias:	Immunosuppression Kidney transplantation Tacrolimus Transplantation conditionning
Acceso en línea:	http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872006001100006
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spelling	oai:scielo:S0034-988720060011000062014-01-24Retiro precoz de esteroides en la inmunosupresión del trasplante renal pediátricoDelucchi B,AngelaValenzuela A,MarcelaFerrario B,MarioLillo D,Ana MaríaGuerrero G,José LuisRodríguez S,EugenioCano Sch,FranciscoCavada Ch,GabrielGodoy L,JorgeRodríguez H,JorgeGonzález G,GloriaBuckel B,ErwinContreras M,Luis Immunosuppression Kidney transplantation Tacrolimus Transplantation conditionning Background: Cardiovascular risk, growth failure and the new immunosuppressive drugs, have encouraged steroid withdrawal or total avoidance with promising results in renal transplant (Tx) immunosuppression. Aim: To evaluate a new immunosuppressor protocol with early withdrawal of steroids in pediatric kidney transplant. Patients and methods: Prospective study in pediatric patients older than 1 year and low immunological risk. Group A (n =28): steroids in decreasing doses until day 7 post Tx, tacrolimus (FK) and micophenolate mofetil (MMF). Group B (n =28) control: steroids, cyclosporine and azathioprine or steroids, FK and MMF. In both groups the induction therapy included basiliximab. Anthropometric and biochemical variables (renal function, lipid profile, hematological, blood glucose and acid-base equilibrium), acute rejection and CMV infection, were evaluated. Mean values and variations for continuous variables were calculated at months 1, 6, 12 and 18. Results: Two children were withdrawn before month 2, one had an untreatable diarrhea and the second died due to Aspergillus septicemia. Mean values at months 1, 6, 12 and 18 for groups A and B: Creatinine clearence (ml/min): 85.4 vs 89; 79.9 vs 83; 89 vs 80; 79.8 vs 80.6 (p: ns); hematocrit (%): 28.8 vs 30.4; 31.7 vs 34.4; 34.4; 32.4 vs 34.8; 34.4 vs 35.5 (p: ns). Total cholesterol (mg/dl): 151 vs 206; 139 vs 174; 138 vs 186; 140 vs 180 (p <0.05). Mean delta height/age Z score at the first year: 0.5 vs 0.15; 0.7 vs 0.22; 0.97 vs 0.25 (p <0.05). Mean systolic blood pressure Z score: 0.9 vs 1.5; 0.5 vs 0.9; -0.3 vs 0.8; 0.1 vs 1.0 (p <0.05). The height/age Z score was significantly superior in patients without steroids. A normalization of growth patterns at month 18 was observed (< 0.05). Both groups presented a negative variation of creatinine clearance during the follow-up, but it was minor in the study group (p <0.05). Two acute rejections were found in each group, and no difference in CMV infections was observed. Conclusions: Early steroid withdrawal in pediatric renal transplant recipients was effective and safe and did not increase the risk of rejectioninfo:eu-repo/semantics/openAccessSociedad Médica de SantiagoRevista médica de Chile v.134 n.11 20062006-11-01text/htmlhttp://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872006001100006es10.4067/S0034-98872006001100006
institution	Scielo Chile
collection	Scielo Chile
language	Spanish / Castilian
topic	Immunosuppression Kidney transplantation Tacrolimus Transplantation conditionning
spellingShingle	Immunosuppression Kidney transplantation Tacrolimus Transplantation conditionning Delucchi B,Angela Valenzuela A,Marcela Ferrario B,Mario Lillo D,Ana María Guerrero G,José Luis Rodríguez S,Eugenio Cano Sch,Francisco Cavada Ch,Gabriel Godoy L,Jorge Rodríguez H,Jorge González G,Gloria Buckel B,Erwin Contreras M,Luis Retiro precoz de esteroides en la inmunosupresión del trasplante renal pediátrico
description	Background: Cardiovascular risk, growth failure and the new immunosuppressive drugs, have encouraged steroid withdrawal or total avoidance with promising results in renal transplant (Tx) immunosuppression. Aim: To evaluate a new immunosuppressor protocol with early withdrawal of steroids in pediatric kidney transplant. Patients and methods: Prospective study in pediatric patients older than 1 year and low immunological risk. Group A (n =28): steroids in decreasing doses until day 7 post Tx, tacrolimus (FK) and micophenolate mofetil (MMF). Group B (n =28) control: steroids, cyclosporine and azathioprine or steroids, FK and MMF. In both groups the induction therapy included basiliximab. Anthropometric and biochemical variables (renal function, lipid profile, hematological, blood glucose and acid-base equilibrium), acute rejection and CMV infection, were evaluated. Mean values and variations for continuous variables were calculated at months 1, 6, 12 and 18. Results: Two children were withdrawn before month 2, one had an untreatable diarrhea and the second died due to Aspergillus septicemia. Mean values at months 1, 6, 12 and 18 for groups A and B: Creatinine clearence (ml/min): 85.4 vs 89; 79.9 vs 83; 89 vs 80; 79.8 vs 80.6 (p: ns); hematocrit (%): 28.8 vs 30.4; 31.7 vs 34.4; 34.4; 32.4 vs 34.8; 34.4 vs 35.5 (p: ns). Total cholesterol (mg/dl): 151 vs 206; 139 vs 174; 138 vs 186; 140 vs 180 (p <0.05). Mean delta height/age Z score at the first year: 0.5 vs 0.15; 0.7 vs 0.22; 0.97 vs 0.25 (p <0.05). Mean systolic blood pressure Z score: 0.9 vs 1.5; 0.5 vs 0.9; -0.3 vs 0.8; 0.1 vs 1.0 (p <0.05). The height/age Z score was significantly superior in patients without steroids. A normalization of growth patterns at month 18 was observed (< 0.05). Both groups presented a negative variation of creatinine clearance during the follow-up, but it was minor in the study group (p <0.05). Two acute rejections were found in each group, and no difference in CMV infections was observed. Conclusions: Early steroid withdrawal in pediatric renal transplant recipients was effective and safe and did not increase the risk of rejection
author	Delucchi B,Angela Valenzuela A,Marcela Ferrario B,Mario Lillo D,Ana María Guerrero G,José Luis Rodríguez S,Eugenio Cano Sch,Francisco Cavada Ch,Gabriel Godoy L,Jorge Rodríguez H,Jorge González G,Gloria Buckel B,Erwin Contreras M,Luis
author_facet	Delucchi B,Angela Valenzuela A,Marcela Ferrario B,Mario Lillo D,Ana María Guerrero G,José Luis Rodríguez S,Eugenio Cano Sch,Francisco Cavada Ch,Gabriel Godoy L,Jorge Rodríguez H,Jorge González G,Gloria Buckel B,Erwin Contreras M,Luis
author_sort	Delucchi B,Angela
title	Retiro precoz de esteroides en la inmunosupresión del trasplante renal pediátrico
title_short	Retiro precoz de esteroides en la inmunosupresión del trasplante renal pediátrico
title_full	Retiro precoz de esteroides en la inmunosupresión del trasplante renal pediátrico
title_fullStr	Retiro precoz de esteroides en la inmunosupresión del trasplante renal pediátrico
title_full_unstemmed	Retiro precoz de esteroides en la inmunosupresión del trasplante renal pediátrico
title_sort	retiro precoz de esteroides en la inmunosupresión del trasplante renal pediátrico
publisher	Sociedad Médica de Santiago
publishDate	2006
url	http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872006001100006
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Retiro precoz de esteroides en la inmunosupresión del trasplante renal pediátrico

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