title: Defining the risk of elective cyclosporine withdrawal in stable kidney transplant recipients.
abstract: Although it is known that elective cyclosporine (CsA) withdrawal increases the risk for acute rejection, few studies have been large enough to identify risk factors for acute rejection after CsA withdrawal. We examined risk factors for acute rejection in 464 kidney transplant recipients who underwent elective CsA withdrawal. The incidence of acute rejection within 6 months of CsA withdrawal was 20/141 (14.2%) in the period January 1986 to May 1989, but only 14/323 (4.5%) since May 1989 (p = 0.0002). Among those transplanted since May 1989, the incidence was 5/20 (25%) for those with both 2 HLA-B and 2 HLA-DR mismatches, compared with only 9/298 (3.0%) for those with fewer mismatches (p < 0.0001). In Cox proportional hazards analysis, risk factors for acute rejection within 6 months, or at any time after elective CsA withdrawal, were date of transplant January 1986 to May 1989 (compared with more recently May 1989 to March 1999), younger age, obesity, as well as B and DR mismatches. Recipient race (83% were white), acute rejection during the first year before withdrawal (31%), mycophenolate mofetil (17%), and other variables failed to predict postwithdrawal acute rejection. We concluded that avoiding CsA withdrawal in the relatively small number of recipients with both 2 HLA-B and 2 HLA-DR mismatches could further reduce our already low incidence of acute rejection following elective CsA withdrawal.
authors.affiliation: Department of Medicine, Hennepin County Medical Center, Minneapolis, MN, USA.
authors.forename: Shakeel
authors.initials: S
authors.lastname: Anjum
authors.forename: Magdalena Adeva
authors.initials: MA
authors.lastname: Andany
authors.forename: Jeffrey C
authors.initials: JC
authors.lastname: McClean
authors.forename: Barbara
authors.initials: B
authors.lastname: Danielson
authors.forename: Bertram L
authors.initials: BL
authors.lastname: Kasiske
mesh_terms: D000961:Antilymphocyte Serum / Q000627:therapeutic use; D016001:Confidence Intervals; D016572:Cyclosporine / Q000009:adverse effects* / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000139:chemically induced / Q000453:epidemiology*; D006085:Graft Survival / Q000276:immunology / Q000502:physiology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D015994:Incidence; D016030:Kidney Transplantation / Q000276:immunology* / Q000401:mortality; D008775:Methylprednisolone / Q000627:therapeutic use; D011241:Prednisone / Q000627:therapeutic use; D012189:Retrospective Studies; D012307:Risk Factors; D013375:Substance Withdrawal Syndrome / Q000209:etiology*; D015996:Survival Rate; D013997:Time Factors; D017211:Treatment Failure
chemical_list: D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D011241:Prednisone; D008775:Methylprednisolone