Introduction: Our center has offered steroid minimized, thymoglobulin induction to our pediatric renal transplant patients for the last 10 years. Steroid minimization or avoidance in previous studies has shown favorable results in survival, function, and growth in pediatric patients. We describe our experience over the last 10 years with this protocol.
Methods: A retrospective chart review was performed for pediatric renal transplant patients on the steroid minimized protocol between 1-1-2002 and 12-31-2011, on an intention to treat basis. Patient demographics, height, weight, serum creatinine, iothalamate GFR (iGFR), biopsies, and survival data were collected. Height and weight z-scores were calculated using EpiInfo 7, using the CDC 2000 growth charts. Survival was calculated using Kaplan-Meier regression. Estimated GFR (eGFR) was calculated using the original and modified Schwartz equations.
Results: Fifty pediatric patients were identified between ages 13 months-19 years. The patients were 58% male, 84% white, 12% black, 4% Hispanic. Forty-four percent of transplants were pre-emptive, and 62% were from cadaveric donors. The top diagnoses were obstructive uropathies (22%), unknown (16%), and dysplasia (12%). Five year survival was 97.2% overall, for cadaveric donor recipients 95%, and 100% for living donor recipients. Only 6% lost graft function. One patient had intra-graft PTLD that resolved spontaneously without chemotherapy. Height delta z scores from transplant to 1, 3, and 5 years were 0.33, 0.06, and 0.26, respectively. Weight delta z scores from transplant to 1, 3, and 5 years were 0.8, -0.16, and 0.19 respectively. One year eGFR was 95.1 ± 30.8 (original Schwartz) and 67± 22.1 (modified Schwartz). Average iGFR was 76.6±16.4 at 1 year and 69.0± 13.4 at three years.
Conclusions: A steroid minimized protocol is safe and provides favorable improvement in growth and stable graft function in pediatric renal transplant patients. The modified Schwartz equation may be a better estimate of true GFR in these patients.
To cite this abstract in AMA style:Warejko J, Hmiel S. Ten-Year Experience in Pediatric Renal Transplant Using Thymoglobulin Induction and Steroid Minimization [abstract]. Am J Transplant. 2013; 13 (suppl 5). http://atcmeetingabstracts.com/abstract/ten-year-experience-in-pediatric-renal-transplant-using-thymoglobulin-induction-and-steroid-minimization/. Accessed November 19, 2017.
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