Experience with deflazacort in children and adolescents after renal transplantation

Deflazacort (DFZ) has been proposed as an alternative drug for immunosuppre ssion after renal transplantation (TX), with fewer side effects than conven tional glucocorticoids. We investigated renal function, body growth, body f at, and bone mineral density (BMD) after switching from oral methylpredniso lone (MPR) to equivalent doses of DFZ 1-9 years after TX in 20 patients age d 5-20 years, selected because of severe adverse effects from previous ster oid therapy. At conversion the patients received a mean dose of 7.4+/-2.4 m g DFZ/m(2) per day. The drug was continued for a mean of 3.7 (1.2-5.5) year s. Under DFZ, the glomerular filtration rate dropped slightly (NS). A singl e rejection episode occurred. Growth velocity significantly improved in the Ist year on DFZ treatment and height standard deviation score (SDS) increa sed steadily after introduction of DFZ (from -2.64 to -1.96 after 4 years, P=0.06). However, in 10 prepubertal children the height gain (+0.20 SDS in 2 years on DFZ) was not significant and the overall mean annual growth rate after TX was similar to that in 10 matched prepubertal TX children on cont inued MPR treatment. Relative obesity, estimated from mean body mass index corrected for height, was reduced from +1.11 SDS at the start of DFZ to +0. 71 SDS after 2 years (P=0.03) and to +0.39 SDS after 4 years (NS). BMD-SDS of the lumbar spine (L2-4) increased after 1 year on DFZ (P=0.005). In conc lusion, DFZ is well tolerated and safe in pediatric patients after TX. It i mproves relative obesity and bone mineralization. However, body growth is n ot significantly influenced pre puberty.