Triple immunosuppression with subsequent prednisolone withdrawal: 6 years' experience in paediatric renal allograft recipients

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Abstract
Thirty-four children (≤15 years of age) with end-stage renal failure received 39 renal allografts between 1985 and 1991 and were treated with cyclosporin A (CyA), azathioprine and low-dose prednisolone (PNL). We aimed to withdraw PNL by 6 months after transplantation. Median duration of follow-up was 2 years 4 months (range 0.1 month to 6 years, 4 months). There were no deaths. Crude graft survival for living-related grafts (n=9) was 100%, although only 1 patient has been followed for >2 years. For cadaveric grafts (n=30), 1- and 5-year actuarial graft survivals were 90% and 79% respectively. At 12 months posttransplant, the median (range) glomerular filtration rate for all patients was 63 (19–109) ml/min per 1.73 m2 (n=25) and at 5 years was 48 (17–64) ml/min per 1.73 m2 (n=9). Complications observed included rejection episodes which occurred after discontinuation of PNL. Long-term (after 12 months), 28% of patients remain on PNL. Hypertension was present in more than 50% of patients. Severe CyA nephrotoxicity was not seen. Catch-up growth as determined by the change (Δ) in mean height standard deviation score (Ht-SDS) was noted at 1 year [ΔSDS/year=+0.60;Pn=18)] and at 2 years [ΔSDS/year=+0.27;Pn=16)] in pre-pubertal patients. The median Ht-SDS at 2 years for pre-pubertal children was −0.71 SD and growth velocity did not improve thereafter. In pubertal patients, the mean ΔSDS per year at 1 year (n=7) was +0.43 and at 2 years (n=4) was +0.17. The catch-up growth in pubertal patients did not reach statistical significance. It was concluded that the use of this immunosuppression regime was associated with an excellent patient and graft survival. Catch-up growth is especially encouraging in pre-pubertal patients. However routine discontinuation of PNL may require review.