Transplant Recipients Fare Better Without Corticosteroids

Transplant Recipients Fare Better Without Corticosteroids

May 10, 2007 (San Francisco) — Measurements of a new biological marker, C4d deposition, add to the evidence that patients undergoing transplantation fare better without corticosteroids, Anjali A. Satoskar, MD, a fellow in renal transplant pathology at Ohio State University in Columbus, Ohio, told attendees at the American Transplant Congress.

The data support the practice of avoiding steroids for immunosuppression in transplant patients, Dr. Satoskar told Medscape. “It certainly reduces the rate of acute rejections in general,” she said.

The Ohio State Comprehensive Transplant Center changed its regimen for acute rejection prophylaxis in kidney and pancreas transplant patients gradually between April 2002 and July 2003, from a steroid regimen (prednisone, mycophenolate mofetil, and cyclosporine) to a steroid-free regimen (rapamycin and cyclosporine).

Retrospectively, Satoskar and her colleagues analyzed the data on 2 groups of patients: 726 who were steroid free (SF); and 279 who were maintained on steroids (SM). Of the SF patients, 156 (21.5%) were biopsied for C4d deposition in the first year after transplant; of the SM patients, 122 (44 %) were biopsied. C4d is a marker for the antibody-antigen reaction involved in acute humoral rejection.

The investigators found that fewer SF patients (14.2 %) had C4d deposition than SM patients (26.2%). In a univariable analysis, the difference was significant (P = .01).

The data were confounded because the demographics of the 2 populations were significantly different, requiring a multivariable analysis to determine which factors correlated most significantly with C4d analysis.

In the multivariable analysis, steroid avoidance correlated best with a higher rate of C4d deposition (P = .009). African-American race also correlated significantly (P = .04), as did female sex (P = .04).

The differences in the populations, who were treated in different time periods, weaken the evidence of the study, said John J. Friedewald, MD, a nephrologist at Northwestern University in Chicago, Illinois, who was one of the session’s moderators. “Unfortunately it was not a randomized trial,” he commented. “When you’re looking at 2 different eras, it’s sometimes hard to draw conclusions.”

However, he said, several other papers presented during the session reinforced the notion that transplant patients don’t need steroids for immunosuppression. “A lot of centers, including mine, are steroid free,” he said. “But two thirds of the centers still use steroids, and those of us who don’t wonder why.”

This study was financed by Ohio State University. Neither Dr. Satoskar nor Dr. Friedewald report any relevant financial relationships.

American Transplant Congress: Abstract 446. Presented May 8, 2007.