title: Late corticosteroid withdrawal can be safely performed for kidney recipients with stable graft function under pathological confirmation.
abstract: Corticosteroid withdrawal (CSWD) protocols to minimize the risk of cardiovascular events after kidney transplantation have been reported. However, most of them were within one year post-transplant, and the pathological survey after CSWD was poorly done. We conducted the present retrospective study to elucidate the usefulness and safety of late-steroid withdrawal more than one year after transplantation in kidney recipients with pathological evaluation. Twenty kidney recipients with stable graft function more than one year post-transplant, and whose corticosteroid (CS) was withdrawn were enrolled in this study. The change in their clinical parameters of graft function (sCr and uP/Cr), metabolic profiles, and histological graft status (Banff 97 scoring system) were studied pre- and post-CSWD, and compared with a control cohort taking continuous CS. The dose of CS was tapered gradually and has been maintained with the minimal dose of CS (1.25-5 mg of prednisone) by three months after transplant. CS was furthermore reduced thereafter, if graft function had been stable more than one year and a patient wanted CS to be withdrawn, then a graft biopsy was undertaken. CSWD was accomplished between 16 and 195 (median 41.5) months post-transplant, if there was no significant histological graft damage or on-going acute rejection. A repeat biopsy was carried out two to 21 months after CSWD. In contrast, the observation point of the control cohort was 24 to 49 (median 36.5) months after transplant, and the second biopsy was done five to 30 months after the initial biopsy. The control cohort took 2.5 to 5 (median 2.5) mg of prednisone daily. There were no significant alterations of graft function between pre- and post-CSWD (sCr: 1.14 +/- 0.1 and 1.17 +/- 0.1 mg/dL, respectively, p = 0.3299, uP/Cr: 0.12 +/- 0.01 and 0.21 +/- 0.06, respectively, p = 0.0574). The hypertension rate between both groups was not different between double biopsy points. In addition the rates of glucose intolerance and hyperlipidemia were comparable between two points in both cohorts. There was no significant change in the acute/active lesion scoring (2 t1 and 3 i1 were only positive factors before CSWD and they all returned to t0 and i0 after CSWD). Moreover, chronic/sclerosing allograft nephropathy scorings were minimal and similar between pre- and post-CSWD compared with the control. CSWD for more than one year is safe for patients whose graft functions are stable with pathological confirmation; however, a longer follow-up study is warranted.
authors.affiliation: Department of Renal Transplantation, Sapporo City General Hospital, Sapporo, Japan. hiroshi.harada@doc.city.sapporo.jp
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Harada
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Miura
authors.forename: Yayoi
authors.initials: Y
authors.lastname: Ogawa
authors.forename: Toshimori
authors.initials: T
authors.lastname: Seki
authors.forename: Akihisa
authors.initials: A
authors.lastname: Taniguchi
authors.forename: Toshinao
authors.initials: T
authors.lastname: Takenouchi
authors.forename: Masaki
authors.initials: M
authors.lastname: Togashi
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Hirano
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000328:Adult; D000963:Antimetabolites / Q000627:therapeutic use; D001706:Biopsy; D065095:Calcineurin Inhibitors; D004359:Drug Therapy, Combination; D005260:Female; D006085:Graft Survival / Q000187:drug effects*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D007668:Kidney / Q000187:drug effects / Q000473:pathology*; D016030:Kidney Transplantation / Q000534:rehabilitation*; D008297:Male; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D000305:Adrenal Cortex Hormones; D000963:Antimetabolites; D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents