XXXX -free Kidney Transplantation Improves Growth: 2-Year Follow-up of the TWIST Randomized Controlled Trial.

@entity1 @entity228 @entity2348 @entity2098 @entity618 @entity1140
BACKGROUND: @entity228 withdrawal (CW) after pediatric kidney transplantation potentially improves growth while avoiding metabolic and other adverse events. We have recently reported the results of a 196 subject randomized controlled trial comparing early CW ( @entity1140 , @entity618 ( @entity2098 ), daclizumab, and corticosteroids until day 4) with @entity1140 , @entity2098 , and @entity228 continuation (CC). At 6 months, CW subjects showed better growth with no adverse impact on acute rejection or graft survival (Am J Transplant 2010; 10: 828-836). This 2-year investigator-driven follow-up study aimed to determine whether improved growth persisted in the longer term. METHODS: Data regarding growth, graft outcomes and adverse events were collected at 1 year (113 @entity1 ) and 2 years (106 @entity1 ) after transplantation. The primary endpoint, longitudinal growth calculated as delta height standard deviation score, was analyzed using a mixed model repeated measures model. RESULTS: @entity228 withdrawal subjects grew better at 1 year (difference in adjusted mean change, 0.25; 95% confidence interval, 0.10, 0.40; P = 0.001). At 2 years, growth remained numerically better in CW subjects (0.20 (-0.01, 0.41); P = 0.06), and significantly better in prepubertal subjects (0.50 (0.16, 0.84); P = 0.004). @entity2348 was significantly more common in CW subjects at 1 year only. @entity228 withdrawal and CC subjects received similar exposure to both @entity1140 and @entity2098 at 1 and 2 years. No significant difference in @entity1 or graft survival, rejection, estimated glomerular filtration rate, or other adverse events was detected. CONCLUSION: Early CW effectively and safely improves growth up to 2 years after transplantation, particularly in prepubertal @entity1 .
