COMPREHENSIVE REVIEW
Steroid avoidance/withdrawal and maintenance immunosuppression in pediatric kidney transplantation
Sarah J. Kizilbash,
Chelsey J. Jensen,
Anne M. Kouri,
Shanthi S. Balani,
Blanche Chavers,
Corresponding Author
Sarah J. Kizilbash
Pediatric Nephrology, University of Minnesota, Minneapolis, Minnesota, USA
Correspondence
Sarah J. Kizilbash, Pediatric Nephrology, University of Minnesota, 2450 Riverside Avenue, Minneapolis, MN 55454, USA.
Email: [email protected]
Search for more papers by this authorChelsey J. Jensen
Solid Organ Transplant, University of Minnesota, Minneapolis, Minnesota, USA
Search for more papers by this authorAnne M. Kouri
Pediatric Nephrology, University of Minnesota, Minneapolis, Minnesota, USA
Search for more papers by this authorShanthi S. Balani
Pediatric Nephrology, University of Minnesota, Minneapolis, Minnesota, USA
Search for more papers by this authorBlanche Chavers
Pediatric Nephrology, University of Minnesota, Minneapolis, Minnesota, USA
Search for more papers by this authorSarah J. Kizilbash,
Chelsey J. Jensen,
Anne M. Kouri,
Shanthi S. Balani,
Blanche Chavers,
Corresponding Author
Sarah J. Kizilbash
Pediatric Nephrology, University of Minnesota, Minneapolis, Minnesota, USA
Correspondence
Sarah J. Kizilbash, Pediatric Nephrology, University of Minnesota, 2450 Riverside Avenue, Minneapolis, MN 55454, USA.
Email: [email protected]
Search for more papers by this authorChelsey J. Jensen
Solid Organ Transplant, University of Minnesota, Minneapolis, Minnesota, USA
Search for more papers by this authorAnne M. Kouri
Pediatric Nephrology, University of Minnesota, Minneapolis, Minnesota, USA
Search for more papers by this authorShanthi S. Balani
Pediatric Nephrology, University of Minnesota, Minneapolis, Minnesota, USA
Search for more papers by this authorBlanche Chavers
Pediatric Nephrology, University of Minnesota, Minneapolis, Minnesota, USA
Search for more papers by this authorAbstract
Background
Corticosteroids have been an integral part of maintenance immunosuppression for pediatric kidney transplantation. However, prolonged steroid therapy is associated with significant toxicities resulting in several SW/avoidance strategies in recent years.
Method/Objective
This comprehensive review aims to discuss steroid-related toxicities and the safety, efficacy, and benefit of steroid avoidance/withdrawal immunosuppression in pediatric kidney transplant recipients.
Results
Initial studies of SW/avoidance conducted in the setting of CSA and AZA showed an increased incidence of AR but no increase in graft loss or mortality with SW/avoidance maintenance immunosuppression. Studies performed under modern immunosuppression (induction therapy, Tac, and MMF) show no significant increase in AR or graft loss with SW/avoidance immunosuppression. Furthermore, SW/avoidance immunosuppression is associated with significant improvement in growth, BMI, BP control, and lipid profile in pediatric kidney transplant recipients. Despite these data, SW/avoidance remains controversial, and only 40% of pediatric kidney transplant recipients in the United States are currently on SW/avoidance maintenance immunosuppression.
Conclusion
SW/avoidance maintenance immunosuppression is safe and associated with fewer side effects compared with steroid-inclusive maintenance immunosuppression in pediatric kidney transplant recipients.
Open Research
DATA AVAILABILITY STATEMENT
Not applicable as this is a review article.
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