Corticosteroid-free kidney transplantation improves growth: 2-year follow-up of the TWIST randomized controlled trial

Webb, N. J.A. et al. (2015) Corticosteroid-free kidney transplantation improves growth: 2-year follow-up of the TWIST randomized controlled trial. Transplantation, 99(6), pp. 1178-1185. (doi: 10.1097/TP.0000000000000498) (PMID:25539467)

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.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Maxwell, Dr Heather
• Authors: Webb, N. J.A., Douglas, S. E., Rajai, A., Roberts, S. A., Grenda, R., Marks, S. D., Watson, A. R., Fitzpatrick, M., Vondrak, K., Maxwell, H., Jaray, J., Van Damme-Lombaerts, R., Milford, D. V., Godefroid, N., Cochat, P., Ognjanovic, M., Murer, L., McCulloch, M., and Tönshoff, B.
• College/School: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: Transplantation
• Publisher: Lippincott, Williams & Wilkins
• ISSN: 0041-1337