RT Journal Article
SR Electronic
T1 Early Steroid Withdrawal in Repeat Kidney Transplantation
JF Clinical Journal of the American Society of Nephrology
JO CLIN J AM SOC NEPHROL
FD American Society of Nephrology
SP 404
OP 411
DO 10.2215/CJN.05110610
VO 6
IS 2
A1 Mujtaba, Muhammad A.
A1 Taber, Tim E.
A1 Goggins, William C.
A1 Yaqub, Muhammad S.
A1 Mishler, Dennis P.
A1 Milgrom, Martin L.
A1 Fridell, Jonathan A.
A1 Lobashevsky, Andrew
A1 Powelson, John A.
A1 Sharfuddin, Asif A.
YR 2011
UL http://cjasn.asnjournals.org/content/6/2/404.abstract
AB Background and objectives Kidney re-transplantation (KRT) candidates are considered at high risk for graft failure. Most of these patients are kept on a chronic steroid maintenance (CSM) regimen. The safety of early steroid withdrawal (ESW) remains unanswered in KRT. Design, setting, participants, & measurements This study was aimed at comparing the outcomes of ESW and CSM in KRT. Retrospective analysis of 113 KRT patients (ESW, n = 59; CSM, n = 54) was performed. All patients received rabbit anti-thymocyte globulin/steroid induction and were maintained on mycophenolate/tacrolimus (±steroids). Results One- and 5-year patient survival for the ESW and the CSM group were not significantly different (98 versus 96% and 91 versus 88%, respectively; P = 0.991). No significant difference was seen in the graft survival for both groups at 1 and 5 years (98 versus 93% and 80 versus 74%, respectively; P = 0.779). Mean 1- and 5-year estimated GFR was not statistically different between the groups (P = 0.773 and 0.790, respectively). The incidence of acute rejection at 1 year was 17 and 22% in ESW and CSM patients, respectively (P = 0.635). Compared with the ESW group, patients in the CSM group were more likely to be hyperlipidemic (P = 0.044), osteoporotic (P = 0.010), post-transplant diabetics (P = 0.051) and required more medications to control BP (P = 0.004). Conclusions ESW seems to be a reasonable approach in KRT recipients because the short and intermediate patient survival, graft survival, and graft function is comparable to CSM immunosuppression.