TRIPLE IMMUNOSUPPRESSION WITH SUBSEQUENT PREDNISOLONE WITHDRAWAL - 6 YEARS EXPERIENCE IN PEDIATRIC RENAL-ALLOGRAFT RECIPIENTS

Thirty-four children (equal to or less than 15 years of age) with end- stage renal failure received 39 renal allografts between 1985 and 1991 and were treated with cyclosporin A (CYA), azathioprine and low-dose prednisolone (PNL). We aimed to withdraw PNL by 6 months after transpl antation. Median duration of follow-up was 2 years 4 months (range 0.1 month to 6 years 4 months). There were no deaths. Crude graft surviva l for living-related grafts (n = 9) was 100%, although only 1 patient has been followed for >2 years. For cadaveric grafts (n = 30), 1- and 5-year actuarial graft survivals were 90% and 79% respectively. At 12 months posttransplant, the median (range) glomerular filtration rate f or all patients was 63 (19-109) ml/min per 1.73 m(2) (n = 25) and at 5 years was 48 (17-64) ml/min per 1.73 m(2) (n = 9). Complications obse rved included re jection episodes which occurred after discontinuation of PNL. Long-term (after 12 months), 28% of patients remain on PNL. H ypertension was present in more than 50% of patients. Severe CyA nephr otoxicity was not seen. Catch-up growth as determined by the change (t riangle) in mean height standard deviation score (Ht-SDS) was noted at 1 year [triangle SDS/year = +0.60; P <0.001 (n = 18)] and at 2 years [triangle SDS/year = +0.27; P <0.01 (n = 16)] in pre-pubertal patients . The median Ht-SDS at 2 years for pre-pubertal children was -0.71 SD and growth velocity did not improve thereafter. In pubertal patients, the mean triangle SDS per year at 1 year (n = 7) was +0.43 and at 2 ye ars (n = 4) was +0.17. The catch-up growth in pubertal patients did no t reach statistical significance. It was concluded that the use of thi s immunosuppression regime was associated with an excellent patient an d graft survival. Catch-up growth is especially encouraging in pre-pub ertal patients. However routine discontinuation of PNL may require rev iew.