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Corticosteroid-free Kidney Transplantation Improves Growth: 2-Year Follow-up of the TWIST Randomized Controlled Trial

Lookup NU author(s): Dr Milos Ognjanovic

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Abstract

Background. Corticosteroid withdrawal (CW) after pediatric kidney transplantation potentially improves growth while avoiding metabolic and other adverse events. We have recently reported the results of a 196 subject randomized controlled trial comparing early CW (tacrolimus, mycophenolate mofetil (MMF), daclizumab, and corticosteroids until day 4) with tacrolimus, MMF, and corticosteroid continuation (CC). At 6 months, CW subjects showed better growth with no adverse impact on acute rejection or graft survival (Am J Transplant 2010; 10: 828-836). This 2-year investigator-driven follow-up study aimed to determine whether improved growth persisted in the longer term. Methods. Data regarding growth, graft outcomes and adverse events were collected at 1 year (113 patients) and 2 years (106 patients) after transplantation. The primary endpoint, longitudinal growth calculated as delta height standard deviation score, was analyzed using a mixed model repeated measures model. Results. Corticosteroid withdrawal subjects grew better at 1 year (difference in adjusted mean change, 0.25; 95% confidence interval, 0.10, 0.40; P = 0.001). At 2 years, growth remained numerically better in CW subjects (0.20 (-0.01, 0.41); P = 0.06), and significantly better in prepubertal subjects (0.50 (0.16, 0.84); P = 0.004). Bacterial and viral infection was significantly more common in CW subjects at 1 year only. Corticosteroid withdrawal and CC subjects received similar exposure to both tacrolimus and MMF at 1 and 2 years. No significant difference in patient or graft survival, rejection, estimated glomerular filtration rate, or other adverse events was detected. Conclusion. Early CW effectively and safely improves growth up to 2 years after transplantation, particularly in prepubertal children.

Publication metadata

Author(s): Webb NJA, Douglas SE, Rajai A, Roberts SA, Grenda R, Marks SD, Watson AR, Fitzpatrick M, Vondrak K, Maxwell H, Jaray J, Van Damme-Lombaerts R, Milford DV, Godefroid N, Cochat P, Ognjanovic M, Murer L, McCulloch M, Tonshoff B

Publication type: Article

Publication status: Published

Journal: Transplantation

Year: 2015

Volume: 99

Issue: 6

Pages: 1178-1185

Print publication date: 01/06/2015

Acceptance date: 02/09/2014

ISSN (print): 0041-1337

ISSN (electronic): 1534-6080

Publisher: Lippincott Williams & Wilkins

URL: http://dx.doi.org/10.1097/TP.0000000000000498

DOI: 10.1097/TP.0000000000000498

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