Department of Histopathology, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK.
Department of Paediatric Nephrology, Royal Manchester Children's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.
Pediatr Nephrol. 2021 Aug;36(8):2463-2472. doi: 10.1007/s00467-021-04948-6. Epub 2021 Feb 9.
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.
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.
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 m vs. 66.8 mL/min/1.73 m, 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).
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. Graphical abstract.
皮质类固醇最小化免疫抑制方案（CMP）是一种安全减少儿童肾移植后长期暴露相关的不必要药物副作用的方法。在此，我们提供了在我们中心使用的 CMP 治疗的儿童接受长期随访后急性排斥反应和生长的发生率数据。
我们回顾性分析了 2009 年至 2019 年期间在我们中心接受 CMP 治疗并接受随访的所有接受肾移植的儿童。将数据与最近研究中的 5 个对照组进行比较。
本研究共纳入 99 例肾移植受者（平均随访 4.4 年）。与对照组相比，CMP 治疗组移植受者的急性排斥反应累积频率无差异。与无急性排斥反应的受者相比，发生急性排斥反应的受者的移植肾功能在最近一次随访时显著降低（53.7 mL/min/1.73 m 与 66.8 mL/min/1.73 m，p = 0.021）。发生 >1 次急性排斥反应的儿童发生移植肾失功的风险大大增加（p = 0.0009，OR 68.25）。在最近一次随访时，90 例受者中有 64 例（71.1%）的身高正常，年龄较小的受者比年龄较大的受者有更大的追赶生长。与接受 CMP 治疗的受者相比，接受 CMP 治疗的受者身高不足的发生率较低（28.9%比 55.1%，p = 0.0025），肥胖的发生率较低（12.2%比 23.9%，p = 0.031），高血压的发生率较低（35.4%比 68.2%，p<0.0001）。
接受 CMP 治疗的儿童在不增加急性排斥反应风险的情况下，表现出更高的身高增长、更低的肥胖发生率和更低的高血压发生率。
