title: Long-term outcome of early steroid withdrawal after kidney transplantation in African American recipients monitored by surveillance biopsy.
abstract: Generally chronic steroid therapy is standard care for African American (AA) kidney recipients because of their higher incidence of rejections and lower long-term graft survival. This prospective study evaluated the long-term safety and efficacy of early steroid withdrawal (ESW) in AA recipients. A total of 206 recipients were studied; 103 AA and 103 non-AA recipients monitored by serial surveillance biopsies from 1 to 60 months posttransplantation to evaluate subclinical acute rejections (SCAR) and chronic allograft injury (CAI). Biopsy-proven clinical acute rejections (BPAR) and SCAR were treated. Primary end point was BPAR and secondary end points were 5-year SCAR, CAI and survival. Incidences of BPAR was 16% versus 14% (p = 1.0), prevalence of CAI due to hypertension was 48% versus 30% (p = 0.05) and interstitial fibrosis/tubular atrophy was 47% versus 32% (p = 0.05) and the mean serum creatinine levels were 2.1 versus 1.8 mg/dL (p = 0.05) at 5-years in AA versus non-AA recipients. The incidence of SCAR was 23% versus 11% at 1 month (p = 0.04), 12% versus 3% at 3 years (p = 0.04) and 10% versus 1% at 5 years (p = 0.04) in AA and non-AA recipients, respectively. Five-year patient survivals were 81% and 88% (p = 0.09) and graft survivals were 71% and 73%(p = 0.19) in AA and non-AA groups, respectively. After early steroid withdrawal AA kidney recipients have significantly lower renal function and higher SCAR and CAI but 5-year graft survival are comparable to non-AA recipients.
authors.affiliation: Division of Transplantation, Department of Surgery, Drexel University College of Medicine, Philadelphia, PA, USA. akumar01@drexelmed.edu
authors.forename: M S
authors.initials: MS
authors.lastname: Anil Kumar
authors.forename: S
authors.initials: S
authors.lastname: Khan
authors.forename: K
authors.initials: K
authors.lastname: Ranganna
authors.forename: G
authors.initials: G
authors.lastname: Malat
authors.forename: N
authors.initials: N
authors.lastname: Sustento-Reodica
authors.forename: W C
authors.initials: WC
authors.lastname: Meyers
mesh_terms: D000328:Adult; D001741:Black or African American; D001706:Biopsy; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology* / Q000473:pathology / Q000517:prevention & control*; D006085:Graft Survival; D006801:Humans; D007165:Immunosuppression Therapy; D015994:Incidence; D016030:Kidney Transplantation; D019520:Living Donors; D008297:Male; D011446:Prospective Studies; D011507:Proteinuria / Q000453:epidemiology; D013256:Steroids / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D013256:Steroids