Outcomes of Steroid Based Versus Steroid Minimizing Immunosuppression in Pediatric Kidney Transplant Recipients: A <scp>NAPRTCS</scp> Study
Bibliographic record
Abstract
BACKGROUND: Early studies evaluating steroid-minimization (SM) employed immunosuppression that is not representative of the modern era of immunosuppression. We hypothesized that current SM-based immunosuppression protocols offer unique advantages for pediatric kidney transplant recipients (pKTR) without compromising allograft and patient outcomes. METHODS: This is a retrospective study of 3263 pKTR between 2000 and 2019 from the North American Pediatric Renal Trials and Collaborative Studies (NAPRTCS). Study participants were grouped as SM and steroid based (SB) based on corticosteroids use at 30 days post-transplant. Primary outcomes of interest were allograft function and survival. Secondary outcomes included linear growth, obesity and hypertension. RESULTS: A SB regimen was used in 2312 (70.9%) and SM in 951 (29.1%). Comparison of the allograft function showed that SM was associated with a significantly higher estimated glomerular filtration rate (eGFR) at 1, 2, and 3 years post-transplant compared to SB. Kaplan-Meier curves showed that SM was associated with significantly less allograft loss (p = 0.01) compared to SB while there was no significant difference in allograft survival when stratified by induction and steroid regimen (p = 0.49). Multivariate Cox regression showed that the SB regimen was not associated with improved graft survival (hazard ratio 1.38 [0.89-2.16]; p = 0.15). Secondary outcome analysis showed significantly better linear growth and less obesity and hypertension in SM compared to SB. CONCLUSIONS: SM immunosuppression was not associated with decreased allograft rejection, function or survival, and was associated with a reduced risk of secondary complications. In patients receiving contemporary, tacrolimus-based maintenance immunosuppression, a SM regimen may be preferred.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".