2025 Southeastern Residency Conference

Title: Reduced Corticosteroid Dosing in Pediatric Renal Transplant Patients
 
Authors: Alexander Durant, Aubrey Slaughter, Bailey Horne


Objective: To investigate the effects of maintenance corticosteroid dose reduction on blood pressure, hemoglobin A1c, and bone mineral density in pediatric renal transplant patients.
 
Background: Renal transplantation requires immediate and chronic immunosuppression to avoid acute organ rejection, which can compromise the integrity of the transplanted organ and be fatal. Consequently, a lifelong immunosuppressive regimen is required for all renal transplant recipients. One integral component of the backbone immunosuppressive regimen is corticosteroid therapy. In pediatric patients, there is a notable lack of data evaluating the deleterious effects associated with chronic corticosteroid therapy post-renal transplantation, as pediatric patients are often excluded from clinical trials and are consequently underrepresented in the literature. Wellstar MCG Health has recently transitioned from using prednisone or prednisolone doses of 0.1 mg/kg/day to 0.05 mg/kg/day, representing a 50% dose reduction in maintenance corticosteroid therapy. The purpose of this chart review is to investigate the effects of maintenance corticosteroid dose reduction on blood pressure, hemoglobin A1c, and bone mineral density in pediatric renal transplant patients.


Methods: This single-center, observational chart review included pediatric patients followed in the Wellstar MCG Health pediatric renal transplant clinic between 01/01/2022 and 12/31/2024. Exclusions included patients undergoing treatment for renal transplant rejection and patients no longer followed at the pediatric renal transplant clinic. The primary outcomes included a reduction in antihypertensive dosage or number of antihypertensive agents, an improvement in hemoglobin A1c or reduction in hyperglycemic agent dosage, and an improvement in BMD Z-score above -2.0 or a ≥20% improvement from baseline. Data analysis will utilize descriptive statistics for a non-parametric data set (e.g., median, IQR).


Results: A total of 13 patients were included in this chart review. The median patient age was 17 years. There were no notable differences between pre-reduction and post-reduction median systolic or diastolic blood pressure measurements or Z-scores. Dose reduction appeared to be associated with a decrease in median A1c of approximately 0.15 mg/dL. Corticosteroid dose reduction was also linked to a decrease in the number of prescribed osteoporosis medications in 57% of patients. The reduction had little impact on the number of prescribed anti-hypertensive and hyperglycemic agents prescribed per patient.


Conclusions: Corticosteroid dose reduction may contribute to improved glycemic control and a decrease in the number of osteoporosis medications prescribed per renal transplant patient. However, this review did not find a corresponding improvement in bone mineral density or blood pressure readings following the dose reduction.