Alternate-day steroids in paedriatric renal transplantation

Abstract

Severe growth retardation is one of the complications of chronic renal failure that is the most important factor that affects the normal social and academic integration of the uraemic child. This continues to be a problem in the post transplant period, in part caused by the continuing use of steroid immunosuppression. Objective: to evaluate the effect of using alternate day steroids on the growth of transplanted children compared with those treated with daily steroids. Patients and methods: the children were less than 15 years at the time of transplant, and maintained a creatinine of less than 1.5 mg/dl during the 1st year post-transplant. There were no acute rejections of the graft. Group 1 were allocated to alternate-day prednisone, but maintaining the same cumulative dose. Other immunosuppressive therapy remained unchanged. Group 2 continued with the same daily dose of prednisone. Analysis included height/age (z), growth velocity (delta Z) and renal function during a 4 - year study period. The dose of prednisone was between 0.12 and 0.16 mg/kg/day and in the case of alternate-day, dosage was doubled. Statistical analysis used the paired t-test for growth and simple linear regression for renal function, a p value of < 0.05 was considered significant. Results: In group 1 there were 13 patients, 4 boys, with an average age of 10.3 + 2.9 years; group 2 28 patients, 15 boys, average age 9.9 + 2.3 years (ns). In the 4 years of follow up the z values of growth were -2.27/-2.24, -2.09/-2.14, -2.21/-2.41, -1.85/-2.68 and -2.03/-3.12 (p < 0.05) for groups 1 and 2 respectively. The average yearly delta Z was +0.045/-0.111 respectively. There were no differences in renal function between the two groups during follow up. Conclusion: there is an increased growth rate in children receiving alternate day prednisone without affecting the function of the transplanted kidney.