title: Late steroid withdrawal after ABO blood group-incompatible living donor kidney transplantation: high rate of mild cellular rejection.
abstract: BACKGROUND
  Little is known about the safety of steroid withdrawal after ABO blood group-incompatible living donor kidney transplantation.
  
  
  METHODS
  Between September 2005 and November 2007, a total of 15 patients were successfully transplanted over the blood group barrier in our transplantation centers. Similarly to transplant recipients with normal immunological risk, we aimed to taper and eventually stop oral prednisone because of the well-known negative impact of steroids on cardiovascular morbidity and mortality, which in turn is limiting graft survival.
  
  
  RESULTS
  Up to now, patient and graft survival is 100% after a median follow-up of 839 days (range, 513-1281 days). On the basis of serial protocol biopsies, late steroid withdrawal could successfully be performed in only 5 of 11 patients. Nevertheless, the remaining 6 patients showed histologic signs of mild and subclinical acute rejection shortly after complete withdrawal or even during steroid tapering.
  
  
  CONCLUSIONS
  With this elevated risk of at least subclinical acute rejection after late steroid withdrawal, we propose that steroid withdrawal in ABO blood group-incompatible kidney graft recipients should only be performed after a protocol biopsy showing normal tissue and together with a thorough clinical and in doubtful cases also histologic follow-up.
authors.affiliation: Clinic for Transplantation Immunology & Nephrology, University Hospital, Basel, Switzerland. oettlt@uhbs.ch
authors.forename: Tobias
authors.initials: T
authors.lastname: Oettl
authors.forename: Eugenia
authors.initials: E
authors.lastname: Zuliani
authors.forename: Ariana
authors.initials: A
authors.lastname: Gaspert
authors.forename: Helmut
authors.initials: H
authors.lastname: Hopfer
authors.forename: Michael
authors.initials: M
authors.lastname: Dickenmann
authors.forename: Thomas
authors.initials: T
authors.lastname: Fehr
mesh_terms: D000017:ABO Blood-Group System; D000208:Acute Disease; D000284:Administration, Oral; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D001788:Blood Grouping and Crossmatching; D003404:Creatinine / Q000097:blood; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D006084:Graft Rejection / Q000097:blood / Q000209:etiology / Q000473:pathology / Q000517:prevention & control*; D006085:Graft Survival / Q000187:drug effects*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D016030:Kidney Transplantation / Q000009:adverse effects*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011241:Prednisone / Q000008:administration & dosage* / Q000009:adverse effects; D018570:Risk Assessment; D013557:Switzerland; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000017:ABO Blood-Group System; D015415:Biomarkers; D007166:Immunosuppressive Agents; D003404:Creatinine; D011241:Prednisone