Subclinical inflammation and chronic renal allograft injury in a randomized trial on steroid avoidance in pediatric kidney transplantation

M. Naesens, O. Salvatierra, M. Benfield, R. B. Ettenger, V. Dharnidharka, W. Harmon, R. Mathias, M. M. Sarwal

Research output: Contribution to journalArticlepeer-review

35 Scopus citations

Abstract

Steroid avoidance is safe and effective in children receiving kidney transplants in terms of graft function and survival, but the effects on allograft histology are unknown. In this multicenter trial, 130 pediatric renal transplant recipients were randomized to steroid-free (SF; n = 60) or steroid-based (SB; n = 70) immunosuppression, and underwent renal allograft biopsies at the time of graft dysfunction and per protocol at implantation and 6, 12 and 24 months after transplantation. Clinical follow-up was 3 years posttransplant. Subclinical acute rejection was present in 10.6% SF versus 11.3% SB biopsies at 6 months (p = 0.91), 0% SF versus 4.3% SB biopsies at 1 year (p = 0.21) and 0% versus 4.8% at 2 years (p = 0.20). Clinical acute rejection was present in 13.3% SF and 11.4% SB patients by 1 year (p = 0.74) and in 16.7% SF and 17.1% SB patients by 3 years (p = 0.94) after transplantation. The cumulative incidence of antibody-mediated rejection was 6.7% in SF and 2.9% in SB by 3 years after transplantation (p = 0.30). There was a significant increase in chronic histological damage over time (p < 0.001), without difference between SF and SB patients. Smaller recipient size and higher donor age were the main risk factors for chronic histological injury in posttransplant biopsies. This serial, semi-quantitative histological analysis of protocol and indicated biopsies in a prospective, randomized, multicenter trial of steroid-free versus steroid-based immunosuppression in pediatric kidney transplantation shows no detrimental effect of steroid avoidance on chronic histological injury.

Original languageEnglish
Pages (from-to)2730-2743
Number of pages14
JournalAmerican Journal of Transplantation
Volume12
Issue number10
DOIs
StatePublished - Oct 2012

Keywords

  • Chronic allograft nephropathy (CAN)
  • histology
  • kidney allograft
  • pediatric transplantation
  • steroid-free immunosuppression

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