Intermediate-term outcomes with early steroid withdrawal in African-American renal transplant recipients undergoing surveillance biopsy.
BACKGROUND
There is a paucity of data regarding the use of early corticosteroid withdrawal (ESW) in African-American renal allograft recipients, and very few reports with >or=1 year follow-up in all patients.


METHODS
We examined the outcomes of 57 African-American renal allograft recipients with minimum follow-up 12 months who did not receive maintenance steroids after day 4 posttransplant. All patients received thymoglobulin induction, mycophenolate mofetil, and initial tacrolimus (n = 48) or sirolimus (n = 9).


RESULTS
Patient and graft survival were 98% and 96% at 1 year, and 95% and 89% over the entire follow-up period (mean, 23 +/- 8 months). Incidence of acute rejection and cytomegalovirus infection were 18% and 7%, respectively, with mean serum creatinine 1.6 +/- 0.5 and 1.7 +/- 0.9 mg/dL at 6 and 12 months. Of patients with functioning grafts, 84% remained steroid free at 1 year, of which 11 (24%) were also calcineurin inhibitor free. Twenty-seven patients underwent surveillance biopsy at 1 month and 28 at 12 months, with 15 surveyed at both time points. There were significant increases in only 2 of the 6 1997 Banff chronic allograft nephropathy (CAN) category scores in this subgroup, with all mean values remaining <1 (mild in severity) at 1 year. Overall, from 82% to 96% of the 12-month scores were <or=1 in all categories for 28 patients; only 3 patients (11%) had interstitial fibrosis and tubular atrophy scores at least moderate in severity. We did not observe any cases of subclinical acute rejection.


CONCLUSIONS
Our findings suggest that ESW in African-American renal allograft recipients with multiple high-risk factors can produce excellent intermediate-term antirejection and graft functional outcomes with minimal development of CAN at 12 months. Our results will need to be verified in larger numbers of patients with longer follow-up.
Zeng
Xu
X
Department of Laboratory Medicine & Pathology, Wayne State University School of Medicine, Detroit, MI, USA.
El-Amm
Jose M
JM
Doshi
Mona D
MD
Singh
Atul
A
Morawski
Katherina
K
Cincotta
Elizabeth
E
Losanoff
Julian E
JE
West
Miguel S
MS
Gruber
Scott A
SA
D000208:Acute Disease; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D001706:Biopsy / Q000706:statistics & numerical data; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000188:drug therapy* / Q000208:ethnology*; D006085:Graft Survival; D006801:Humans; D007165:Immunosuppression Therapy; D015994:Incidence; D016030:Kidney Transplantation / Q000208:ethnology* / Q000706:statistics & numerical data*; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D014184:Transplantation, Homologous; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones