A comparison of alternate day and daily steroid therapy in children following renal transplantation.

The effects of switching from daily steroid therapy (DST) to alternate day steroids (ADST) was reviewed in 28 children following kidney transplantation. Fifteen of the 28 children could be pair matched for age, sex, height and weight at transplant, time after transplant and renal function with children on DST. We found that catch-up growth occurred in children less than 10 years of age on low dose DST in the first 1 or 2 years post-transplant as long as major growth retarding factors such as renal failure or nephrosis were absent. Switching to ADST resulted in a significant increase in growth velocity in the second year on ADST compared to the parallel time in the matched pairs on DST. However, no significant increase occurred in the first year on ADST and for the total period of ADST which averaged 3.2 years. There was a similar risk of acute rejection episodes and rising serum creatinine levels in the matched ADST groups. However, late episodes of violent acute rejection leading to rapid graft loss were seen only in the ADST group, as long as 6 years post-transplant. Thus, ADST compared to low dose DST offers little growth advantage and, perhaps, this therapy should be reserved for children growing poorly after transplant.