Graft loss from recurrent glomerulonephritis is not increased with a rapid steroid discontinuation protocol.
BACKGROUND
The risk of recurrence of glomerulonephritis in kidney transplant recipients on a steroid-free maintenance immunosuppression protocol is unknown.


METHODS
We studied the 4-year graft and patient survival in 105 adult kidney transplant recipients who received their transplant for glomerulonephritis (GN) and were treated with a protocol incorporating rapid discontinuation of prednisone for 5 days (group 1). We compared these outcomes to two control groups; 439 concurrent recipients who received a transplant for causes other than GN (group 2) and to 260 kidney transplant recipients who received an allograft for GN between 1994 and 1999 and were maintained on a steroid-based immunosuppressive protocol (group 3).


RESULTS
The 4-year graft and patient survival were similar in the three groups. Acute rejection-free survival was also similar. Serial annual serum creatinine and estimated GFR were also comparable amongst the three groups. Two grafts were lost in group 1 from biopsy-proven recurrent GN and eight other subjects had evidence of histological recurrence at 11.2+/-11.9 months. Seven grafts were lost for recurrent disease in group 3 and 15 others had evidence of histological recurrence at 29.1+/-32.6 months. The mean time to graft loss from recurrence was 52+/-22 months.


CONCLUSIONS
A regimen that utilizes rapid discontinuation of steroids conveys no added risk of graft loss from recurrent GN in the short term but longer follow-up is needed. A consideration should be made to discontinue corticosteroids in the potential recipients who are on them at the time of transplantation.
Ibrahim
Hassan
H
Division of Renal Diseases and Hypertension, Department of Surgery, University of Minnesota, Minneapolis, MN, USA. ibrah007@umn.edu
Rogers
Tyson
T
Casingal
Vincent
V
Sturdevant
Mark
M
Tan
Miguel
M
Humar
Abhinav
A
Gillingham
Kristen
K
Matas
Arthur
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D002985:Clinical Protocols; D003404:Creatinine / Q000097:blood; D005260:Female; D005921:Glomerulonephritis / Q000097:blood / Q000150:complications* / Q000401:mortality / Q000601:surgery*; D006084:Graft Rejection / Q000097:blood / Q000209:etiology*; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D013256:Steroids / Q000008:administration & dosage*; D015996:Survival Rate
D007166:Immunosuppressive Agents; D013256:Steroids; D003404:Creatinine