Prednisone-free maintenance immunosuppression-a 5-year experience.
Concern persists that prednisone-free maintenance immunosuppression in kidney transplant recipients will be associated with an increase in late allograft dysfunction and graft loss. We herein report 5-year follow-up of a trial of prednisone-free maintenance immunosuppression. From October 1, 1999, through January 31, 2005, at our center, 589 kidney transplant recipients were treated with a protocol incorporating discontinuation of their prednisone on postoperative day 6. At 5 years, actuarial patient survival was 91%; graft survival, 84%; death-censored graft survival, 92%; acute rejection-free graft survival, 84% and chronic rejection-free graft survival, 87%. The mean serum creatinine level (+/-SD) at 1 year was 1.6 +/- 0.6; at 5 years, 1.7 +/- 0.8. In all, 86% of kidney recipients with functioning grafts remain prednisone-free as of April 30, 2005. As compared with historical controls, recipients on prednisone-free maintenance immunosuppression had a significantly lower rate of a number of complications, including cataracts (p < 0.001), posttransplant diabetes mellitus (p < 0.001), avascular necrosis (p = 0.001), and fractures (p = 0.004). We conclude that prednisone-related side effects can be minimized in a protocol incorporating prednisone-free maintenance immunosuppression. Five-year graft outcome remains good.
Matas
Arthur J
AJ
Department of Surgery, University of Minnesota, Minneapolis, USA. matas001@umn.edu
Kandaswamy
Raja
R
Gillingham
Kristen J
KJ
McHugh
Lois
L
Ibrahim
Hassan
H
Kasiske
Bertram
B
Humar
Abhinav
A
D000890:Anti-Infective Agents / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D002386:Cataract / Q000209:etiology; D003022:Clotrimazole / Q000627:therapeutic use; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood; D003622:Dapsone / Q000627:therapeutic use; D003920:Diabetes Mellitus / Q000209:etiology; D050723:Fractures, Bone / Q000209:etiology; D015774:Ganciclovir / Q000031:analogs & derivatives / Q000627:therapeutic use; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007165:Immunosuppression Therapy; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D016030:Kidney Transplantation / Q000379:methods*; D009336:Necrosis / Q000209:etiology; D009761:Nystatin / Q000627:therapeutic use; D010419:Pentamidine / Q000627:therapeutic use; D011241:Prednisone / Q000008:administration & dosage*; D013997:Time Factors; D014184:Transplantation, Homologous / Q000379:methods; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use; D000077562:Valganciclovir
D000890:Anti-Infective Agents; D000935:Antifungal Agents; D000998:Antiviral Agents; D007166:Immunosuppressive Agents; D009761:Nystatin; D010419:Pentamidine; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D003622:Dapsone; D003404:Creatinine; D003022:Clotrimazole; D000077562:Valganciclovir; D015774:Ganciclovir; D011241:Prednisone