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Acute rejection and growth outcomes in paediatric kidney allograft recipients treated with a corticosteroid minimisation immunosuppressive protocol

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Abstract

Background

Corticosteroid minimisation immunosuppressive protocols (CMP) for children are an approach to safely reduce unwanted medication side effects associated with long-term exposure following kidney transplantation. Here, we provide data regarding the incidence of acute rejection and growth over an extended follow-up in children receiving the CMP used in our centre.

Methods

We retrospectively analysed all children treated with a CMP who received a kidney transplant and had follow-up care in our centre between 2009 and 2019. Data were compared to 5 control groups from recent studies.

Results

Ninety-nine kidney allograft recipients were included in the study (mean follow-up 4.4 years). There was no difference in the cumulative frequency of acute rejection in CMP-treated graft recipients compared to controls. Graft function at latest follow-up was significantly lower in graft recipients experiencing acute rejection compared to those without acute rejection (53.7 mL/min/1.73 m2 vs. 66.8 mL/min/1.73 m2, p = 0.021). Children experiencing >1 acute rejection episode had a greatly elevated risk of graft failure (p = 0.0009, OR 68.25). At latest follow-up, 64/90 (71.1%) graft recipients had a normal height, and younger graft recipients demonstrated greater catch up growth than older children. CMP-treated graft recipients showed a reduced rate of height deficit (28.9% vs. 55.1%, p = 0.0025), less obesity (12.2% vs. 23.9%, p = 0.031), and reduced rates of hypertension (35.4% vs. 68.2%, p< 0.0001).

Conclusions

Children treated with a CMP show greater height attainment, lower frequency of obesity, and reduced rates of hypertension, without an increased risk of acute rejection.

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Acknowledgements

We thank Prof. Rachel Lennon and Dr. Nick Plant for their advice during the preparation of this manuscript.

Funding

The study was supported by a Jean Shanks/Pathological Society Clinical Lecturer Grant (Grant reference: JSPS CLG 2019 02) (awarded to JM).

Author information

Authors and Affiliations

  1. Department of Histopathology, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke’s Hospital, Cambridge, UK

    James McCaffrey

  2. Department of Paediatric Nephrology, Royal Manchester Children’s Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK

    Mohan Shenoy

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  1. James McCaffrey
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Contributions

JM and MS designed the study and analysed data. Both authors contributed to the preparation of the manuscript.

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Correspondence to Mohan Shenoy.

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The study was assessed by the RMCH research and development department at the time of study inception, and it was confirmed that formal ethical approval was not required for this case note review study. No patient identifiable data were recorded.

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The authors declare no competing interests.

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McCaffrey, J., Shenoy, M. Acute rejection and growth outcomes in paediatric kidney allograft recipients treated with a corticosteroid minimisation immunosuppressive protocol. Pediatr Nephrol 36, 2463–2472 (2021). https://doi.org/10.1007/s00467-021-04948-6

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