Growth after conversion to alternate-day corticosteroids in children with renal transplants: a single-center study
During the 1980s all children with growth potential and stable/adequate renal function at 6–9 months after kidney transplantation underwent conversion to alternate-day corticosteroids in an attempt to maximize growth. Conversion was attempted in 79 of 160 children who received allografts during this decade and was considered successful if they remained on alternate-day prednisone for more than 1 year, with a calculated creatinine clearance of at least 75% of the pre-conversion baseline value. Conversion succeeded in 55 children but failed in 24. Growth was markedly improved among those successfully converted when compared with the failure group, as measured by standard deviation score for growth velocity based on chronological age (+0.94±1.58 vs. −0.86±1.53,P<0.001) and bone age (+0.49±0.61 vs. −1.24±1.47,P<0.001). The improved growth among the successfully converted patients is believed to have been related to the combined effects of lower corticosteroid dose (0.36±0.16 vs. 0.48±0.21 mg/kg per day,P<0.02) and better renal function (calculated creatinine clearance 87±32 vs. 47±21 ml/min per 1.73 m2,P<0.001) at 1 year post conversion. Two factors appeared to improve the likelihood of successful conversion: the use of cyclosporine and receiving a live-related rather than cadaver transplant. Cyclosporine was associated with improvement in the overall rate for successful conversion in all recipients, from 59% to 83% (P<0.05). Recipients of allografts from live-related donors underwent successful conversion in 90% of cases compared with 58% receiving cadaver allografts (P<0.05). Successful conversion to alternate-day corticosteroid therapy is of significant benefit for linear growth, but may be associated with a risk of rejection and loss of renal function. The risk is small in live-related recipients and has been made safer for cadaver recipients with the introduction of cyclosporine.