Rapid steroid withdrawal in hepatitis C virus-positive kidney transplant recipients.
The effects of rapid steroid withdrawal (SW) on kidney transplantation (KT) outcome were investigated in 12 HCV+ patients in a prospective cohort study. These results were compared with 17 HCV+ patients who received KT in the prior 2 yr and treated with a standard prednisone taper protocol. SW patients received only 6 d of steroid treatment after transplantation. Eleven received Thymoglobulin and one Basiliximab induction treatment along with a calcineurin inhibitor and mycophenolate mofetil. Patient and graft survival was 92% in SW group (median follow-up 12 months, range 6-17), and 92 and 82% in the historic control group respectively (median follow-up 21 months, range 11-27). In the SW and control group, acute rejection rates were 9 and 18%, and mean creatinine levels at last follow-up 1.30 +/- 0.36 and 1.68 +/- 0.58 mg/dL respectively. Only two SW patients had an increase in liver function tests during follow-up (18%), compared with six patients in the control group (43%). This study demonstrates that rapid SW is safe for HCV+ KT recipients, without an increase in acute rejection episodes or liver function abnormalities in the short term.
Akalin
Enver
E
Department of Nephrology, Mount Sinai School of Medicine, New York, NY 10029-6574, USA. enver.akalin@msnyuhealth.org
Murphy
Barbara
B
Sehgal
Vinita
V
Ames
Scott
S
Daly
Lisa
L
Bromberg
Jonathan S
JS
D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D000077552:Basiliximab; D016572:Cyclosporine / Q000008:administration & dosage; D018450:Disease Progression; D004359:Drug Therapy, Combination; D004655:Emulsions; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006526:Hepatitis C / Q000601:surgery*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016030:Kidney Transplantation / Q000379:methods*; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use; D011239:Prednisolone / Q000008:administration & dosage*; D011446:Prospective Studies; D011993:Recombinant Fusion Proteins; D016559:Tacrolimus / Q000008:administration & dosage; D016896:Treatment Outcome
D000911:Antibodies, Monoclonal; D004655:Emulsions; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D011993:Recombinant Fusion Proteins; D016572:Cyclosporine; D000077552:Basiliximab; D011239:Prednisolone; D009173:Mycophenolic Acid; D016559:Tacrolimus