ESPN 51th Annual Meeting

ESPN 2018


 
STEROID FREE IMMUNOSUPPRESSION IN RENAL TRANSPLANTATION: IS IT REALLY WORTH IT?
SANGEET SIDHU 1 NICHOLAS WEBB 1 NICHOLAS PLANT 1 AMRIT KAUR 1 DEAN WALLACE 1 DENISE ROBERTS 1 MOHAN SHENOY 1

1- ROYAL MANCHESTER CHILDRENS HOSPITAL
 
Introduction:

There is an increasing role for steroid free immunosuppression protocols following the TWIST study. However, there are concerns regarding the adverse effects of mycophenolate mofetil (MMF) in children.

Material and methods:

The primary aim of our study is looking at MMF withdrawal rates in patients who were initiated on the TWIST protocol. Secondary aims were incidence of biopsy proven acute rejections (BPAR), weight loss >10%, the prevalence of overweight/obesity and hypertension.

We analysed 83 children (59 boys and 24 girls) transplanted in our centre from June 2009 to December 2016 who had a functioning graft and a minimum follow-up of 12 months.

Results:

MMF withdrawal occurred in 22 (27%) children – 9 at 6 months, 14 at 12 months and 22 at 24 months post-transplant. MMF was discontinued due to chronic diarrhoea in 7 (31%), recurrent infections in 5 (23%), weight loss > 10% in 4 (18%), neutropenia (absolute neutrophil < 1.0) in 3 (14%) and persistent BK viraemia in 3 (14%). Incidence of BPAR was 20% (17) in the first 12 months (9 Banff IA, 5 Banff IB, 2 Banff 2A and 1 Banff 2B). All episodes responded to pulse IV methylprednisolone therapy. There was no graft loss from acute rejection in the first 12 months following the transplant. The prevalence of overweight children was 16% (13) and obesity was 6% (5) at 12 months post-transplant in our cohort, compared to the UK prevalence of 29% and 24% respectively in a similar cohort. The prevalence of hypertension necessitating medical therapy  was 50% (41) in our cohort.

Conclusions:

Whilst MMF based steroid free immunosuppression is associated with low prevalence of overweight/obesity, there is high incidence of MMF withdrawal due to gastrointestinal side-effects, recurrent infections and severe weight loss.