Clinicopathologic evaluation of short-term outcome after early corticosteroid discontinuation in kidney transplantation.
OBJECTIVE
Steroids have been a gold-standard drug of immunosuppressive regimens in kidney transplantation. Steroid minimization protocols have been applied to minimize the adverse effects of steroids. We have evaluated the short-term outcomes of our early steroid discontinuation regimen.


METHODS
A total of 128 recipients who received kidney from ABO-compatible, flow crossmatch-negative living-related donors were included in this study. Immunosuppressive regimens consisted of tacrolimus (TAC), mycophenolate mofetil (MMF), and basiliximab. In a cohort of recipients, designated as a steroid early discontinuation (ESD) group, only three doses of methylprednisolone (MP) were given (500, 250, 125 mg). In the other cohort of recipients, designated as a chronic steroid (CS) group, MP was given chronically, being tapered to 4 mg at one month post-transplant. TAC and mycophenolic acid (MPA) blood levels were monitored. The following data were retrospectively compared between the two groups at 1, 3, 6, 9, 12 months post-transplant: serum creatinine (sCr), urine protein per gCr (uP/Cr), the incidence of biopsy-proven acute rejection (BPAR), graft survival (GS), area-under-the-curve of blood levels of tacrolimus (TAC-AUC(0-12), ng h/mL) and mycophenolic acid (MPA-AUC(0-12), mug h/mL), MMF dose (mg), the incidence of opportunistic infection, post-transplant diabetes mellitus (PTDM), and histopathologic findings of protocol biopsy according to the Banff '07 classification.


RESULTS
sCr and uP/Cr were comparable between the two groups up to 12 months except for sCr at one month (ESD group > CS group). TAC-AUC(0-12) was significantly higher in ESD group at one month but was equivalent thereafter, while the prevalence of biopsy-proven tubulotoxicity was not different. MMF dose was comparable throughout the period between two groups. The incidence of BPAR until 12 months was equivalent. Of note, 60% of BPAR cases in ESD group occurred within one month. Prevalence of opportunistic infection or PTDM was equivalent. Graft survival was 100% in both groups. The following histopathologic scores up to 12 months were also equivalent: t, i, g, v, ci, ct, cg, cv, mm, ah, and ptc.


CONCLUSIONS
Favorable short-term outcomes were achieved both clinically and histologically using our early steroid discontinuation protocol compared with the conventional protocol with chronic steroid treatment.
Miura
Masayoshi
M
Department of Urology, Hokkaido University Hospital, Sapporo, Japan. miumiu@med.hokudai.ac.jp
Ogawa
Yayoi
Y
Kubota
Kanako C
KC
Harada
Hiroshi
H
Shimoda
Naohiko
N
Seki
Toshimori
T
Hirano
Tetsuo
T
Nonomura
Katsuya
K
D000328:Adult; D001706:Biopsy; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000627:therapeutic use*; D006084:Graft Rejection / Q000453:epidemiology / Q000473:pathology* / Q000517:prevention & control; D006085:Graft Survival; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D016030:Kidney Transplantation / Q000473:pathology*; D008297:Male; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D028761:Withholding Treatment
D005938:Glucocorticoids