الفهرس 
Steroid withdrawal in pediatric kidney transplant recipients
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Abstract
Background: Corticosteroid have been used extensively as a corner stone of maintenance immunosuppression post transplantation. However, serious side effects have been associated with their use particularly in children. Corticosteroids minimization strategies are developed to avoid their side effects. The aim of the study is to evaluate the effect of early steroid withdrawal in low to moderate risk pediatric kidney transplant recipients on the graft through sequential protocol graft biopsy obtained one week, one month and three months post-transplant and correlation of biopsy findings with patient clinical data enrolled with different immunosuppressive protocols. Methods: This is a prospective interventional cohort study that included 15 living donor renal transplant recipients being followed up at Kidney Transplantation Outpatient Clinic, Cairo university Children`s Hospital (Abo Elreesh). Steroid withdrawal was applied to 6 cases, after excluding patients with high immunological risk. Protocol biopsies were taken at 1 week (in cases with steroid withdrawal only); 1 month and 3 months post transplantation to diagnose subclinical rejection. Results: 83% of cases with steroid withdrawal developed rejection and resumed steroids again. 20%, 33% and 13% of all recipients developed subclinical rejection detected by protocol biopsy at 1 week, 1 month and 3 months post-transplantation. Acute subclinical rejection episodes at one month were significantly higher in steroid withdrawal group compared to steroid maintenance group (p =0.03)