title: African-American renal transplant recipients benefit from early corticosteroid withdrawal under modern immunosuppression.
abstract: African-Americans (AAs) have historically been considered high-risk renal transplant recipients due to increased rejection rates and reduced long-term graft survival. As a result, AAs are often excluded from corticosteroid withdrawal (CSWD) protocols. Modern immunosuppression has reduced rejections and improved graft survival in AAs and may allow successful CSWD. Outcomes in 56 AAs were compared to 56 non-AAs. All patients were enrolled in one of four early CSWD protocols. Results are reported as AA versus non-AA. Acute rejection at 1-year was 23% and 18%; (p = NS); creatinine clearance at 1-year was 75 versus 80 mL/min (p = NS); patient and graft survival was 96% versus 98% and 91% versus 91%; (p = NS). AAs benefit from early CSWD with significantly improved blood pressure, LDL < 130 mg/dL and HDL > 45 mg/dL at 1-year, post-transplant diabetes of 8.7%, and mean weight change at 1-year of 4.8 +/- 7.2 kg. In conclusion, early CSWD in AAs is associated with acceptable rejection rates, excellent patient and graft survival, and improved cardiovascular risk, indicating that the risks and benefits of early CSWD are similar between AAs and non-AAs. Additional follow-up is needed to determine long-term renal function, graft survival, and cardiovascular risk in AAs with early CSWD.
authors.affiliation: Department of Surgery, Division of Transplantation, University of Cincinnati, Cincinnati, OH, USA.
authors.forename: Robyn E
authors.initials: RE
authors.lastname: Boardman
authors.forename: Rita R
authors.initials: RR
authors.lastname: Alloway
authors.forename: J Wesley
authors.initials: JW
authors.lastname: Alexander
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Buell
authors.forename: Michael
authors.initials: M
authors.lastname: Cardi
authors.forename: M Roy
authors.initials: MR
authors.lastname: First
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Hanaway
authors.forename: Rino
authors.initials: R
authors.lastname: Munda
authors.forename: Christin C
authors.initials: CC
authors.lastname: Rogers
authors.forename: Prabir
authors.initials: P
authors.lastname: Roy-Chaudhury
authors.forename: Brian
authors.initials: B
authors.lastname: Susskind
authors.forename: Jennifer
authors.initials: J
authors.lastname: Trofe
authors.forename: E Steve
authors.initials: ES
authors.lastname: Woodle
mesh_terms: D000305:Adrenal Cortex Hormones / Q000494:pharmacology*; D001741:Black or African American; D006084:Graft Rejection / Q000188:drug therapy / Q000453:epidemiology; D006085:Graft Survival / Q000187:drug effects; D006801:Humans; D007165:Immunosuppression Therapy; D016030:Kidney Transplantation; D013534:Survival; D013997:Time Factors
chemical_list: D000305:Adrenal Cortex Hormones