New Study Finds Children Don’t Need Long-Term Steroids After Kidney Transplant

New Study Finds Children Don’t Need Long-Term Steroids After Kidney Transplant Researchers at Helen DeVos Children’s Hospital Implement New Protocol to Eliminate Side Effects from Steroids

Research at Helen DeVos Children’s Hospital demonstrates long-term steroid use is not needed for children who have undergone a kidney transplant. Steroids are traditionally used indefinitely as anti-rejection therapy, which may produce significant side effects including stunted growth, obesity, diabetes, acne, mood changes and insulin resistance. Findings of the retrospective study are published in the August 2009 issue of Pediatric Transplantation.

“My partners and I have seen the negative impact steroids have on children,” said Timothy E. Bunchman, MD, senior author of the study and division chief of nephrology and transplantation, Helen DeVos Children’s Hospital. “When we started the kidney transplant program at Helen DeVos Children’s Hospital five years ago we set out to provide the best treatment based on the specific needs of the pediatric population. Adult treatment protocols are routinely applied to children. Our research was designed to confirm that’s not the best treatment for children.”

Traditional protocols call for patients to slowly reduce steroid use and continue on a low dose indefinitely. Bunchman’s study looked at rapidly reducing steroid use and eventually discontinuing use. Nineteen patients were rapidly weaned off steroids from 2005 to 2008. Seventeen patients responded well to the protocol and were tapered off. Two patients had a recurrence of their primary diseases and were weaned off their steroids on a modified discontinuation pattern.

“This protocol enables kids to fit with peers and not be different based on appearance from a medical experience,” added Bunchman. “In school pictures and plays, you’d never know they’d had a transplant because they don’t have the classic ‘moon face’ of children on steroids.”

Below is an example of the protocol used in this study.

Sample Protocol

Number of Days Post-Op	Typical Dose of Milligram Prednisone Protocol	Helen DeVos Children’s Hospital Milligram Dose Prednisone Protocol
1	80	80
‘2	60	40
3	40	20
4	30	10
5	30	5
6	30	n/a
7	25	n/a
14	20	n/a
30	15	n/a
60	10	n/a
90	10	n/a

Normalized physical appearance is not the only benefit. Anecdotal reporting indicates steroid avoidance increases medication adherence, particularly in adolescents.

“Medication compliance helps prevent rejection,” added Bunchman. “Simplifying the medicine regimen, reducing the number of anti-rejection medications the patient must take and reducing the adverse effects improves compliance and saves costs both in terms of hospitalization rates and the cost of the medications.”

Twenty-five patients have undergone a kidney transplant since the program’s inception in 2005. The average length of stay is just 6.5 days, which is shorter than the national average length of stay with 100 percent kidney acceptance and zero rejection rate. Bunchman anticipates this study’s protocol will become standard practice within 10 years. He also indicates no other children’s hospital in Michigan follows the “steroid-off” protocol.

Additional authors of the study include: Gina Marie Barletta, MD, Eric Kirk, MD, John J. Gardner, RN, Joshua F. Rodriguez, CHT, and Sheri M. Bursach, RN.

Watch Dr. Bunchman speak about this study and the growth of the nephrology program at Helen DeVos Children’s Hospital here or watch him speak about the study here.

Helen DeVos Children’s Hospital is a Grand Rapids-based hospital serving children throughout Michigan. A teaching hospital, it includes more than 150 pediatric specialty physicians with specialized training in providing medical and surgical care to children in more than 40 pediatric specialties. We care for 7,600 children on an inpatient basis and 190,000 children at outpatient sites annually. The staff at Helen DeVos Children’s Hospital is committed to caring for children and families with compassion, excellence and innovation. The children’s hospital is one of seven hospitals in the Spectrum Health system. Visit devoschildrens.org to learn more or devoschildrens.org/2011 to learn about the new hospital opening in 2011.