Outcome at 3 years with a prednisone-free maintenance regimen: a single-center experience with 349 kidney transplant recipients.
Historically, late steroid withdrawal after kidney transplants has been associated with an increased rejection rate. Recently, low rejection rates have been reported for recipients treated with complete avoidance or rapid elimination of steroids. However, follow-up has been short. We herein report on 3-year outcome in recipients whose prednisone was rapidly eliminated and who were maintained on a steroid-free regimen. From 10/1/1999 through 5/1/2003, 349 recipients (254 LD, 95 CAD; 319 in first 30 s) were immunosuppressed with polyclonal antibody (Thymoglobulin), a calcineurin inhibitor, either mycophenolate mofetil or sirolimus, and rapid discontinuation of prednisone. Actuarial 3-year patient survival was 95%; graft survival, 93%. Acute rejection-free graft survival at 1 year was 94%; at 3 years, 92%. There was no difference between LD and CAD. At 2 years, the mean (+/- SE) serum creatinine level for LDs was 1.6 +/- 0.5 mg/dL; for CAD, 1.6 +/- 0.4 mg/dL. We have no new cases of PTLD or avascular necrosis; 22 recipients (6%) developed CMV. Currently, 84% of recipients remain prednisone-free. We conclude that excellent 3-year patient and graft survival can be achieved without maintenance prednisone. With such a protocol, steroid-related side-effects are minimal.
Khwaja
Khalid
K
Department of Surgery, University of Minnesota, Minneapolis, MN.
Asolati
Massimo
M
Harmon
James
J
Melancon
J Keith
JK
Dunn
Ty
T
Gillingham
Kristen
K
Kandaswamy
Raja
R
Humar
Abhinav
A
Gruessner
Rainer
R
Payne
William
W
Najarian
John
J
Dunn
David
D
Sutherland
David
D
Matas
Arthur J
AJ
D000961:Antilymphocyte Serum / Q000627:therapeutic use; D016022:Case-Control Studies; D003404:Creatinine / Q000097:blood; D005260:Female; D006084:Graft Rejection / Q000188:drug therapy*; D006085:Graft Survival; D006801:Humans; D007165:Immunosuppression Therapy; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016030:Kidney Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use; D009336:Necrosis; D011241:Prednisone / Q000008:administration & dosage*; D020123:Sirolimus / Q000627:therapeutic use; D013997:Time Factors
D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents; D003404:Creatinine; D009173:Mycophenolic Acid; D011241:Prednisone; D020123:Sirolimus