title: Successful tapering of immunosuppression to low-dose monotherapy steroids after living-related human leukocyte antigen-identical renal transplantation.
abstract: BACKGROUND
  Living-related (LR) human leukocyte antigen (HLA)-identical renal transplant (RTx) recipients often receive standard immunosuppression, despite the absence of mismatched major HLA-antigens and the known complications of long-term use of immunosuppression. No data are available on the need for immunosuppression for these specific patients. We wondered whether their immunosuppressive load could be radically reduced.
  
  
  METHODS
  Between November 1982 and November 2005, 83 LR HLA-identical RTx were performed in our center. Their unadjusted graft survival was 74% at 10 years. In 29 patients (median time after transplantation 5.6 [range 1.0-21.4] years) with stable uncompromised renal function, we tapered their immunosuppression from triple or dual therapy to prednisolone 5 mg/day. Follow up on prednisolone monotherapy was at least 24 months.
  
  
  RESULTS
  In 27 of 29 patients reduction of immunosuppression to prednisolone monotherapy was uneventful. One patient, using dual therapy, developed JC-virus nephropathy resulting in graft loss. One refused further discontinuation of his medication. Four (15%) of the 27 patients on monotherapy developed biopsy-proven recurrence of their original disease. Only one of them showed a transient decline in renal function. One additional patient developed minor proteinuria and a rise in serum creatinine level, as a result of chronic urinary tract infections. The remaining 23 of 27 patients (85%) had an uneventful follow up during 24 months prednisolone monotherapy.
  
  
  CONCLUSIONS
  We conclude that HLA-identical LR RTx recipients who are at least 1 year after transplantation might be treated with low-dose steroid monotherapy. Close surveillance of patients for recurrence of their original disease is recommended to allow for potential early therapeutic intervention.
authors.affiliation: Department of Internal Medicine and Transplantation, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands. j.vandewetering.1@erasmusmc.nl
authors.forename: Jacqueline
authors.initials: J
authors.lastname: van de Wetering
authors.forename: Jeroen H
authors.initials: JH
authors.lastname: Gerrits
authors.forename: Nicole M
authors.initials: NM
authors.lastname: van Besouw
authors.forename: Jan N M
authors.initials: JN
authors.lastname: Ijzermans
authors.forename: Willem
authors.initials: W
authors.lastname: Weimar
mesh_terms: D000328:Adult; D000368:Aged; D004334:Drug Administration Schedule; D005190:Family; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006085:Graft Survival; D006680:HLA Antigens / Q000032:analysis*; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods*; D007674:Kidney Diseases / Q000145:classification / Q000601:surgery; D016030:Kidney Transplantation / Q000276:immunology*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011239:Prednisolone / Q000627:therapeutic use*; D012189:Retrospective Studies; D016019:Survival Analysis; D055815:Young Adult
chemical_list: D005938:Glucocorticoids; D006680:HLA Antigens; D011239:Prednisolone