Early Steroid Withdrawal in Repeat Kidney Transplantation

Early Steroid Withdrawal in Repeat Kidney Transplantation

Published ahead of print on November 4, 2010
Clinical Journal of the American Society of Nephrology
© 2010 American Society of Nephrology
doi: 10.2215/CJN.05110610

Muhammad A. Mujtaba*, Tim E. Taber*, William C. Goggins{dagger}, Muhammad S. Yaqub*, Dennis P. Mishler*, Martin L. Milgrom{dagger}, Jonathan A. Fridell{dagger}, Andrew Lobashevsky{ddagger}, John A. Powelson{dagger}, and Asif A. Sharfuddin*

* Division of Nephrology, Department of Medicine, {dagger} Division of Transplant, Department of Surgery, and {ddagger} Transplant Immunology Laboratory, Indiana University School of Medicine, Indianapolis, Indiana

Correspondence: Dr. Muhammad A. Mujtaba, Indiana University School of Medicine/Clarian Transplant Institute, Department of Medicine, Division of Nephrology, 550 N. University Boulevard, Suite UH4601, Indianapolis, IN 46202. Phone: 317-274-7534; Fax: 317-948-3268; E-mail: mmujtaba@iupui.edu

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.

http://cjasn.asnjournals.org/cgi/content/abstract/CJN.05110610v1