title: Recipient age and mycophenolate mofetil as the main determinants of outcome after steroid withdrawal: analysis of long-term follow-up in renal transplantation.
abstract: The long-term benefit of steroid withdrawal on patient and graft survival is unproven. Steroids were stopped within the first year after kidney transplantation in 223 consecutive low-risk patients initially treated with thymoglobulin and triple-drug therapy. The 15-year actuarial graft survival rate was 83.9%. Risk factors for graft loss were: proteinuria (hazard ratio [HR]: 6.96, P = 0.0003), creatinine >130 micromol/L (HR: 3.37, P = 0.01), recipient age <35 years (HR: 5.31, P = 0.001), and no mycophenolate mofetil (MMF) treatment (HR: 8.83, P = 0.04). Interestingly, recipient age and no MMF treatment were not risk factors in higher-risk patients in whom steroids were continued. The 2-year incidence of acute rejection following steroid withdrawal was 12.1%; the graft survival rate was lower in this group (71.1%). Our findings indicate that late steroid withdrawal results in excellent long-term outcome in most low-risk patients, but it should be attempted with caution in younger patients and when MMF is not used.
authors.affiliation: Department of Nephrology and Clinical Immunology, Tours University Hospital, Tours, France.
authors.forename: Inass
authors.initials: I
authors.lastname: Laouad
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Halimi
authors.forename: Matthias
authors.initials: M
authors.lastname: Büchler
authors.forename: Azmi
authors.initials: A
authors.lastname: Al-Najjar
authors.forename: Valérie
authors.initials: V
authors.lastname: Chatelet
authors.forename: Hubert
authors.initials: H
authors.lastname: Nivet
authors.forename: Yvon
authors.initials: Y
authors.lastname: Lebranchu
mesh_terms: D000328:Adult; D000375:Aging / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival / Q000187:drug effects; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000494:pharmacology; D012307:Risk Factors; D013256:Steroids / Q000008:administration & dosage* / Q000494:pharmacology; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D013256:Steroids; D009173:Mycophenolic Acid