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Original ArticlesRenal Transplantation
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Early Steroid Withdrawal in Repeat Kidney Transplantation

Muhammad A. Mujtaba, Tim E. Taber, William C. Goggins, Muhammad S. Yaqub, Dennis P. Mishler, Martin L. Milgrom, Jonathan A. Fridell, Andrew Lobashevsky, John A. Powelson and Asif A. Sharfuddin
CJASN February 2011, 6 (2) 404-411; DOI: https://doi.org/10.2215/CJN.05110610
Muhammad A. Mujtaba
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Tim E. Taber
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William C. Goggins
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Muhammad S. Yaqub
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Dennis P. Mishler
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Martin L. Milgrom
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Jonathan A. Fridell
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Andrew Lobashevsky
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John A. Powelson
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Asif A. Sharfuddin
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  • Figure 1.
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    Figure 1.

    Kaplan-Meier (A) graft survival and (B) patient survival of KRT recipients with the ESW and CSM immunosuppression regimen.

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    Figure 2.

    Graft function comparison expressed as (A) serum creatinine (mg/dl) and (B) eGFR (ml/min per 1.73 m2) of KRT recipients with the ESW and CSM immunosuppression regimen. The P value was not statistically significant for all time points.

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    Figure 3.

    Graft function comparison using eGFR (ml/min per 1.73 m2) of KRT recipients with the ESW and CSM immunosuppression regimen by dividing them according to organ source: (A) living donor (LD) and (B) deceased donor (DD). The P value was not statistically significant for all time points.

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    Table 1.

    Donor and recipient characteristics

    ESW (n = 59)CSM (n = 54)P
    Recipient
        age (years)42 + 1343 + 120.975
        male66% (n = 39)59% (32)0.452
        ethnicity
            white78% (46)81% (44)0.642
            African American19% (11)11% (6)0.263
            others3% (2)8% (4)0.341
        ESRD diagnosis
            GN34% (20)48% (26)0.123
            congenital24% (14)21% (11)0.667
            hypertension17% (10)11% (6)0.373
            diabetes mellitus13% (8)7% (4)0.289
            others12% (7)13% (7)0.859
        PRA34 + 2537 + 310.562
        HLA mismatch(A,B,DR)3.4 + 1.73.3 + 1.80.821
        follow-up (days)1105 (118 to 2105)1786 (31 to 2608)<0.0001
        time on HD (years)2.6 (1.0 to 6.0)1.6 (0.4 to 5.7)0.422
        graft survival first Tx (days)3249 (3 to 10,105)2892 (8 to 12,784)0.601
        pre-emptive KRT15% (9)17% (9)0.837
        number of Tx
            287% (51)83% (45)0.644
            38% (5)13% (7)0.439
            45% (3)4% (2)0.721
    Donor
        living donor37% (22)31% (17)0.516
        deceased donor63% (37)69% (37)0.516
        age (years)35 + 1537 + 130.455
        male49% (29)59% (32)0.281
        BMI27 + 526 + 50.626
        ethnicity
            white88% (52)85% (46)0.644
            African American9% (5)11% (6)0.636
            others3% (2)4% (2)0.928
        cause of death
            trauma35% (13)38% (14)0.809
            anoxia41% (15)32% (12)0.468
            CVA19% (7)27% (10)0.789
            others5% (2)3% (1)0.555
    Kidney
        delayed graft function7% (4)9% (5)0.722
        pulsatile perfusion
            yes78% (29)68% (25)0.295
            no14% (5)19% (7)0.528
            unknown8% (3)13% (5)0.454
        total warm ischemia time (minutes)33 + 531 + 50.103
        cold ischemia time (hours)16 + 714 + 50.165
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    Table 2.

    Rejection, graft loss, steroid exposure and metabolic profile comparison

    ESWCSMP
    Biopsy proven rejection20% (n = 12)26% (14)0.509
    Time to rejection (days)63 (14 to 1258)205 (6 to 1285)0.819
    Type of rejection
        acute cellular rejection92% (11)72% (10)0.330
        acute antibody mediated rejection8% (1)28% (4)0.330
    Graft loss7% (4)15% (8)0.231
    Cause for current graft loss
        rejection25% (1)50% (4)0.575
        BK nephropathy25% (1)0
        death with functioning graft50% (2)50% (4)1.00
    Cumulative steroid exposure prior to recent Tx (days)3834 (3 to 10,105)3600 (8 to 12,784)0.552
    Cause of prior graft loss
        chronic transplant glomerulopathy68% (40)79% (43)0.363
        rejection17% (10)13% (7)0.839
        glomerulonephritis5% (3)4% (2)0.934
        others10% (6)4% (2)0.408
    Metabolic Profile
        systolic blood pressure (mmHg)128 + 12129 + 170.792
        diastolic blood pressure (mmHg)72 + 1274 + 110.314
        serum albumin (gm/dl)4 + 0.53.7 + 0.50.005
        fasting blood glucose (mg/dl)104 + 27101 + 300.741
        serum cholesterol (mg/dl)154 + 33153 + 340.866
        serum LDL (mg/dl)84 + 2980 + 220.457
        post transplant diabetes mellitus1.6% (1)11% (6)0.051
        anti lipid therapy44% (26)70% (38)0.007
        no. of blood pressure medications1.8 + 12.6 + 1.30.004
        bisphosphonate therapy10% (6)35% (19)0.010
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Clinical Journal of the American Society of Nephrology: 6 (2)
Clinical Journal of the American Society of Nephrology
Vol. 6, Issue 2
1 Feb 2011
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Early Steroid Withdrawal in Repeat Kidney Transplantation
Muhammad A. Mujtaba, Tim E. Taber, William C. Goggins, Muhammad S. Yaqub, Dennis P. Mishler, Martin L. Milgrom, Jonathan A. Fridell, Andrew Lobashevsky, John A. Powelson, Asif A. Sharfuddin
CJASN Feb 2011, 6 (2) 404-411; DOI: 10.2215/CJN.05110610

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Early Steroid Withdrawal in Repeat Kidney Transplantation
Muhammad A. Mujtaba, Tim E. Taber, William C. Goggins, Muhammad S. Yaqub, Dennis P. Mishler, Martin L. Milgrom, Jonathan A. Fridell, Andrew Lobashevsky, John A. Powelson, Asif A. Sharfuddin
CJASN Feb 2011, 6 (2) 404-411; DOI: 10.2215/CJN.05110610
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