关键词: 激素减撤 , 儿童肾移植 , 身高增长 , 急性排斥反应

Abstract:

Objective To compare the safety and efficacy between steroid withdrawal/avoidance regimenand steroid-based immunosuppressive regimen in pediatric renal transplant recipients. Methods The relevant literatures of steroid withdrawal/avoidance regimen and steroid-based regimen in pediatric renal transplant recipients were searched in the databases of PubMed，Embase，Cochrane Library，Web of Science，CNKI，Wanfang Data and VIP. The data were evaluated by RevMan 5.4 software. Results A total of 634 patients with 6 randomized controlled trials were included，including steroid withdrawal group（n ＝ 320）and steroid-based group（n ＝ 314）. The results showed significant improvement in height in steroid withdrawal/avoidance group compared with steroid-based group〔MD ＝ 0.39，95%CI（0.14，0.65），P ＜ 0.01〕， and prepuberty patients benefit more from steroid withdrawal/avoidance. The increase in height was not accompanied by an increase in rejection or a decrease in the survival rateof patients and allografts in the short term，and the long-term prognosis was also optimistic. Conclusion Thesteroid withdrawal/avoidance regimen in pediatric renal transplant recipients can significantly improve the growth ofchildren's height，among which the prepuberty patients benefit more. Most importantly，the benefits of growth and development were not at the expense of an increase in acute rejection in the short term，and long-term follow-up data showed that recipient and kidney survival were comparable to those in steroid-based recipients.

Key words:  , Steroid withdrawal； Pediatric kidney transplantation； Growth； Acute rejection（AR）