title: Steroid-free immunosuppression regime reduces both long-term cardiovascular morbidity and patient mortality in renal transplant recipients.
abstract: The aim of this retrospective study was to assess the impact of steroid therapy on cardiovascular disease (CVD) and patient mortality, in 486 on-CsA renal transplant recipients, with a follow-up of 9.5 +/- 4.3 yr. Two hundred and one patients had their steroids permanently withdrawn at sixth month after transplantation (G1); 285 patients did not (G2) as they were unable (acute rejection after suspension) or unsuitable (because of clinical criteria or immunosuppressive protocols). The CVD considered were coronary artery disease diagnosed by angiography and myocardial infarction. G1 and G2 patients were well-matched regarding CVD risk factors, except for age (G1: 44 +/- 14 yr; G2: 40 +/- 12 yr; p < 0.003), incidence of male (G1: 62%; G2: 72%, p < 0.02) incidence of acute rejection (G1: 39%; G2: 83%, p < 0.0001). Both CVD and deaths occurring during the first year of transplantation were excluded from the analysis. At 20 yr, the cumulative probability of developing a CVD, was 3.8% in G1; 23.8% in G2 (p < 0.0005). Patient survival rate was 95% in G1; 62% in G2 (p < 0.003). Mortality caused by CVD was higher in G2 (4.2% vs. 0.5%; p < 0.03). The Cox analysis identified in steroid therapy the main independent risk factors for both CVD (hazard ratio 9.56 p < 0.0001) and patient mortality (hazard ratio 5.99, p < 0.0001). At 10th and 15th year after transplantation, the mean-daily dose of steroids was 4.2 mg. In the long-term, steroid therapy, even in low-doses, increases significantly both the rate of CVD and patient mortality. This retrospective study suggests that steroid-free regime should always be recommended for the prevention of post-transplant CVD. This relevant statement should be followed by a long-term prospective study.
authors.affiliation: Division of Nephrology, University and Spedali Civili, Brescia, Italy. sandrini.silvio@libero.it
authors.forename: Silvio
authors.initials: S
authors.lastname: Sandrini
authors.forename: Roberto
authors.initials: R
authors.lastname: Maffeis
authors.forename: Gisella
authors.initials: G
authors.lastname: Setti
authors.forename: Nicola
authors.initials: N
authors.lastname: Bossini
authors.forename: Paolo
authors.initials: P
authors.lastname: Maiorca
authors.forename: Camilla
authors.initials: C
authors.lastname: Maffei
authors.forename: Simona
authors.initials: S
authors.lastname: Guerini
authors.forename: Roberto
authors.initials: R
authors.lastname: Zubani
authors.forename: Nazario
authors.initials: N
authors.lastname: Portolani
authors.forename: Stefano
authors.initials: S
authors.lastname: Bonardelli
authors.forename: Franco
authors.initials: F
authors.lastname: Nodari
authors.forename: Stefano Maria
authors.initials: SM
authors.lastname: Giulini
authors.forename: Giovanni
authors.initials: G
authors.lastname: Cancarini
mesh_terms: D000328:Adult; D003327:Coronary Disease / Q000401:mortality / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods*; D016030:Kidney Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000517:prevention & control*; D011183:Postoperative Complications / Q000517:prevention & control; D012189:Retrospective Studies; D013256:Steroids / Q000009:adverse effects
chemical_list: D013256:Steroids