Late steroid withdrawal and cardiovascular events in kidney transplant recipients.
BACKGROUND
Cardiovascular events (CVE) are the leading cause of mortality in kidney transplant recipients. The adverse effects of long-term therapy with steroids on cardiovascular risk have motivated increasing interest in steroid withdrawal (SW). The objective of this study was to compare the incidences of CVE and all-cause mortality between patients who had undergone SW at 1 year posttransplant and control patients who continued on steroids.


METHODS
A cohort of 400 consecutive adult recipients of a kidney transplant between 1993 and 1998 who qualified for late SW was studied. At 1 year posttransplant 188 patients underwent SW, whereas 212 patients continued on steroids. Cox proportional-hazards analysis was used to estimate CVE (cardiac and cerebrovascular events) and all-cause mortality hazard ratios (HR) for patients who had undergone SW versus controls who continued on steroids beyond 1 year.


RESULTS
The average follow-up was 61 months. There were 44 (11%) cardiac events, 18 (4.5%) cerebrovascular events, and 41 deaths (10.3%). The composite outcome of CVE and all-cause mortality was reached in 26 (13.8%) subjects who had undergone SW and 50 (23.6%) controls (P=0.013). In adjusted analyses, SW was associated with decreased risk for the composite outcome (HR 0.46, 95% confidence interval [CI] 0.28-0.76), cardiac events (HR 0.48, 95% CI 0.28-0.84), and all-cause mortality (HR 0.27, 95% CI 0.12-0.59). There was no association of SW with the risk for cerebrovascular events (HR 1.76, 95% CI 0.45-7.01).


CONCLUSIONS
In this retrospective analysis, SW at 1 year posttransplant was associated with decreased risk for future CVE and all-cause mortality.
Arnol
Miha
M
Transplant Medicine, Renal Transplant Program, Oregon Health and Science University, Portland, OR 97239, USA.
de Mattos
Angelo M
AM
Chung
Jae S
JS
Prather
Jonathan C
JC
Mittalhenkle
Anuja
A
Norman
Douglas J
DJ
D000305:Adrenal Cortex Hormones / Q000009:adverse effects*; D000328:Adult; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D002561:Cerebrovascular Disorders / Q000453:epidemiology / Q000401:mortality; D015331:Cohort Studies; D004334:Drug Administration Schedule; D005260:Female; D006331:Heart Diseases / Q000453:epidemiology / Q000401:mortality; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D044469:Racial Groups; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors
D000305:Adrenal Cortex Hormones