Subclinical inflammation and chronic renal allograft injury in a randomized trial on steroid avoidance in pediatric kidney transplantation
| Autor: | Naesens, M, Salvatierra, O, Benfield, M, Ettenger, RB, Dharnidharka, V, Harmon, W, Mathias, R, Sarwal, MM, SNS01-NIH-CCTPT Multicenter Trial |
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| Rok vydání: | 2012 |
| Předmět: |
Graft Rejection
Male Kidney Disease Adolescent pediatric transplantation Clinical Trials and Supportive Activities Renal and urogenital kidney allograft Medical and Health Sciences histology Rare Diseases Chronic allograft nephropathy Clinical Research steroid-free immunosuppression Humans Child Pediatric Transplantation SNS01-NIH-CCTPT Multicenter Trial Evaluation of treatments and therapeutic interventions Organ Transplantation Kidney Transplantation 6.1 Pharmaceuticals Steroids Female Surgery 6.4 Surgery Immunosuppressive Agents |
| Zdroj: | American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons, vol 12, iss 10 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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