Outcomes of Steroid Based Versus Steroid Minimizing Immunosuppression in Pediatric Kidney Transplant Recipients: A NAPRTCS Study.

BACKGROUND

Early studies evaluating steroid-minimization (SM) employed immunosuppression that is not representative of the modern era of immunosuppression. We hypothesized that current SM-based immunosuppression protocols offer unique advantages for pediatric kidney transplant recipients (pKTR) without compromising allograft and patient outcomes.

METHODS

This is a retrospective study of 3263 pKTR between 2000 and 2019 from the North American Pediatric Renal Trials and Collaborative Studies (NAPRTCS). Study participants were grouped as SM and steroid based (SB) based on corticosteroids use at 30 days post-transplant. Primary outcomes of interest were allograft function and survival. Secondary outcomes included linear growth, obesity and hypertension.

RESULTS

A SB regimen was used in 2312 (70.9%) and SM in 951 (29.1%). Comparison of the allograft function showed that SM was associated with a significantly higher estimated glomerular filtration rate (eGFR) at 1, 2, and 3 years post-transplant compared to SB. Kaplan-Meier curves showed that SM was associated with significantly less allograft loss (p = 0.01) compared to SB while there was no significant difference in allograft survival when stratified by induction and steroid regimen (p = 0.49). Multivariate Cox regression showed that the SB regimen was not associated with improved graft survival (hazard ratio 1.38 [0.89-2.16]; p = 0.15). Secondary outcome analysis showed significantly better linear growth and less obesity and hypertension in SM compared to SB.

CONCLUSIONS

SM immunosuppression was not associated with decreased allograft rejection, function or survival, and was associated with a reduced risk of secondary complications. In patients receiving contemporary, tacrolimus-based maintenance immunosuppression, a SM regimen may be preferred.