Impact of Minimal Steroid Doses on Post‐Transplant Growth in Pediatric Kidney Recipients, a Retrospective Observational Study

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BACKGROUND: or 0.2 mg/kg/day) is limited. This study evaluated whether low doses of steroid therapy are associated with post-transplant growth failure. METHODS: Single-center retrospective cohort study. In total, 44 pediatric KTx recipients from 2005 to 2024 were collected. Differences in Z-Score and height before 6 months and after 6 and 12 months of KTx were assessed using Friedman rank tests. Linear mixed models were used to analyze the longitudinal effect of steroid therapy on growth outcomes. RESULTS: The mean age at KTx was 11 years (SD ± 3.8). Median prednisolone doses at 3 and 6 months after KTx were 0.23 (p25-75: 0.18-0.41) and 0.21 mg/k/day (0.14-0.28), respectively. The mean-height Z-score improved from -2.35 (SD ± 1.30) to 1.82 (SD ± 1.23) one year post-KTx. The percentage of patients with short stature (height Z-score ≤ -2SD) decreased from 65.1% at baseline (KTx) to 54.8% and 52.3% after 6 and 12 months, respectively. In multivariable analysis, time follow-up and age at KTx were associated with post-transplant growth. Steroid therapy shows a trend to reduce body height, but the interaction was not significant. CONCLUSION: This single-center study found that pediatric KTx recipients receiving low-dose steroid therapy showed post-transplant improvements in height and Z-scores. Notably, the use of low-dose steroids did not significantly impair growth, although a slight downward trend in Z scores was noted.

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