African-American renal transplant recipients benefit from early corticosteroid withdrawal under modern immunosuppression.
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.
Boardman
Robyn E
RE
Department of Surgery, Division of Transplantation, University of Cincinnati, Cincinnati, OH, USA.
Alloway
Rita R
RR
Alexander
J Wesley
JW
Buell
Joseph F
JF
Cardi
Michael
M
First
M Roy
MR
Hanaway
Michael J
MJ
Munda
Rino
R
Rogers
Christin C
CC
Roy-Chaudhury
Prabir
P
Susskind
Brian
B
Trofe
Jennifer
J
Woodle
E Steve
ES
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
D000305:Adrenal Cortex Hormones