Steroid-free immunosuppression after renal transplantation-long-term experience from a single centre.
BACKGROUND
A steroid-free immunosuppressive protocol may improve the general well-being of patients, but long-term renal graft survival has been a concern.


METHODS
In a retrospective clinical study, 329 consecutive transplantations with renal grafts at our centre during the period 1995-2004, were followed for up to 9.3 years. Patients mainly received steroid-free immunosuppression with an initial induction with antithymocyte globulin or basiliximab and maintenance therapy with ciclosporin and mycophenolate mofetil (MMF). Steroids were given after rejection, or if the physician judged it necessary, for instance because of primary kidney disease or when calcineurin inhibitor toxicity was suspected.


RESULTS
About 71% of the patients did not take steroids at all. Nevertheless, graft survival rates at 1, 5 and 7 years were 95, 77 and 72% for all grafts, including 27% living donor transplants and 27% second or subsequent grafts. Ten patients (3.2%) died with functioning grafts. Within the first year of transplantation there were 69 acute rejections in 63 patients (19%). Four cases (1.3%) of post-transplant lymphoproliferative disorder (PTLD) occurred with one graft loss and no deaths. Owing to a high PTLD rate in a previous patient cohort, total immunosuppression was lessened after 1998.


CONCLUSIONS
Steroid avoidance is possible with good results with respect to acute rejection and long-term graft survival. After introducing MMF, largely avoiding muromonab-CD3 mouse raised monoclonal antibody against CD (OKT3), and reducing doses of calcineurin inhibitor, the rates of PTLD did not differ from what is usually found. For the present, induction and use of MMF, together with a calcineurin inhibitor, is probably to be preferred.
Department of Nephrology Y, Odense University Hospital, DK-5000 Odense C, Demark.
Mohamad
M
El-Faramawi
Nils
N
Rohr
Bente
B
Jespersen
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007108:Immune Tolerance; D007166:Immunosuppressive Agents / Q000494:pharmacology*; D016030:Kidney Transplantation / Q000379:methods*; D008232:Lymphoproliferative Disorders / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D016853:Muromonab-CD3 / Q000494:pharmacology; D011183:Postoperative Complications / Q000517:prevention & control; D012189:Retrospective Studies; D013256:Steroids / Q000494:pharmacology*; D016896:Treatment Outcome
D007166:Immunosuppressive Agents; D016853:Muromonab-CD3; D013256:Steroids