title: Outcome at 3 years with a prednisone-free maintenance regimen: a single-center experience with 349 kidney transplant recipients.
abstract: 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.
authors.affiliation: Department of Surgery, University of Minnesota, Minneapolis, MN.
authors.forename: Khalid
authors.initials: K
authors.lastname: Khwaja
authors.forename: Massimo
authors.initials: M
authors.lastname: Asolati
authors.forename: James
authors.initials: J
authors.lastname: Harmon
authors.forename: J Keith
authors.initials: JK
authors.lastname: Melancon
authors.forename: Ty
authors.initials: T
authors.lastname: Dunn
authors.forename: Kristen
authors.initials: K
authors.lastname: Gillingham
authors.forename: Raja
authors.initials: R
authors.lastname: Kandaswamy
authors.forename: Abhinav
authors.initials: A
authors.lastname: Humar
authors.forename: Rainer
authors.initials: R
authors.lastname: Gruessner
authors.forename: William
authors.initials: W
authors.lastname: Payne
authors.forename: John
authors.initials: J
authors.lastname: Najarian
authors.forename: David
authors.initials: D
authors.lastname: Dunn
authors.forename: David
authors.initials: D
authors.lastname: Sutherland
authors.forename: Arthur J
authors.initials: AJ
authors.lastname: Matas
mesh_terms: 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
chemical_list: D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents; D003404:Creatinine; D009173:Mycophenolic Acid; D011241:Prednisone; D020123:Sirolimus