Hair matters: underrated side effect of immunosuppressive therapy in children
A.H. Bouts, M.A. Middelkamp-Hut
Chair(s): Drs. F.M. Molenaar
Thursday 9 march 2017
12:45 - 13:00h
Categories: Poster - Klinisch
Parallel session: Postersessie - Klinisch 5
Background:
Early steroid withdrawal (ESW) after renal transplantation (rtx) in children improves growth and reduces metabolic risks without increasing the number of acute rejections. Hair loss is reported as a non-frequent (1-10%) side effect of tacrolimus (Tac) and mycophenolate mofetil (MMF). Since we switched to an immunosuppressive regimen of ESW combined with Tac, MMF and basiliximab (ESW protocol) we encountered an increased number of children with hair loss, varying from mild to severe. To assess this observation we compared hair loss in children receiving the ESW protocol with children receiving the previous non-ESW schedule.
Methods:
The number of children with hair loss receiving the ESW protocol was compared with those receiving the previous non-ESW schedule (basiliximab plus steroids; plus MMF or azathioprine; plus cyclosporine which is switched to Tac 6 months after rtx). Fisher-exact test was used to compare frequencies.
Results:
Five of 16 (31%) ESW children (median age 11.5 yrs, range 1.7-16,4) and 3 of 13 (23%) non-ESW children (median age 10.7, range 3.2-16.6 yrs) developed hair loss (ns). The onset of hair loss in ESW children was 14,8 (5,3-22,6) months after renal transplantation compared to 30 (9-58) months in non-ESW children. Ten of 16 ESW-children (63%) remained off steroids. 40% (4/10) of children that maintained ESW therapy developed hair loss, which cannot be put aside as a minor nuisance. As an example, a 12-year old girl received a living-related kidney transplant following the ESW-regimen according to TWIST (1). One year after rtx she developed near-total hair loss of the scalp, eyebrows and eyelashes. Other causes such as infection, zinc- and iron deficiency and thyroid disorder were excluded. Prednisolone was reintroduced and Tac tapered to a trough level of around 3 ug/L. MMF dosage was maintained at 600 mg/m2 with a trough level around 2 ug/L. Hair growth recovered but remained thin.
Conclusion:
The number of patients in this study is too small to show significant differences, but ESW treatment might give more hair loss than steroid-based therapy. Hair loss after renal transplantation in children is an underrated problem with a significant cosmetic impact, especially for teen-agers, and is a risk for non-compliance. The cause can be multifactorial and needs more exploration.
1Grenda R et al. A randomized trial to assess the impact of early steroid withdrawal on growth in pediatric renal transplantation: the TWIST study. Am J of Tx 2010;10:828-836
