Figure 1625

Corticosteroids are an integral part of pediatric renal transplantation immunosuppressive protocols. In addition to hypertension and hyperlipidemia, one of the main adverse effects of daily steroid dosing in children is growth retardation. A review of North American Pediatric Renal Transplant Cooperative Study data, looking at the change in the height standard deviation score (SDS) from 30 days after transplantation to 12 to 60 months after transplantation analyzed the difference between the 1477 children treated continuously on a daily or alternate-day steroid regimen. The mean change in SDS was significantly greater for the alternate-day group at each 12-month interval (P < 0.05). Of note is the fact that at 12 months, those children on alternate-day steroids had a mean serum creati-nine of 1.06 ± 0.04 mg/dL as compared with 1.28 ± 0.02 mg/dL for those on daily steroids (P < 0.001). Alternate-day therapy also was more common in children without a rejection episode in the first 12 months after transplantation, recipients of living donor grafts, white recipients, and children 2 to 12 years of age at the time of transplantation. (From Jabs and coworkers [27]; with permission.)

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