title: Early (fifth day) vs. late (sixth month) steroid withdrawal in renal transplant recipients treated with Neoral(®) plus Rapamune(®): four-yr results of a randomized monocenter study.
abstract: The most advisable timing for steroid withdrawal (CSWD) after renal transplantation (Tx) is still an open issue. This randomized study has compared early CSWD (at day 5) with late (at month 6) in patients under Neoral + Sirolimus. The primary end point was the percentage of success in CSWD at month 48. Ninety-six transplants from deceased donors were randomized to withdraw steroids either early (n = 49) or late (n = 47). At four yr, the two strategies were comparable for: success in CSWD (65% in both), graft survival (95% and 98%), patient survival (92% and 96%) creatininemia (1.7 ± 0.3 and 1.6 ± 0.4 mg/dL), side effects, being still on Sirolimus + Neoral (69% and 74%), reversibility of rejection (AR) (all cases), severity of AR (grade 1A/1B: 81% and 63%). The major differences were incidence of AR: at month twelve (48% vs. 30%, p < 0.04), at 48 (53% and 33%, p < 0.03); timing of AR (72 ± 86 d vs. 202 ± 119 d, p < 0.0001). The timing of CSWD influences neither the rate of successful CSWD nor the long-term results. However, early suspension causes a higher AR rate, mostly arising within month one, but always responsive to steroids. Yet, the early appearance of AR can make patient management easier and safer.
authors.affiliation: Division of Nephrology, A.O. Spedali Civili and University, Brescia, Italy. sandrini.silvio@libero.it
authors.forename: Silvio
authors.initials: S
authors.lastname: Sandrini
authors.forename: Gisella
authors.initials: G
authors.lastname: Setti
authors.forename: Nicola
authors.initials: N
authors.lastname: Bossini
authors.forename: Raffaella
authors.initials: R
authors.lastname: Chiappini
authors.forename: Francesca
authors.initials: F
authors.lastname: Valerio
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Mazzola
authors.forename: Roberto
authors.initials: R
authors.lastname: Maffeis
authors.forename: Franco
authors.initials: F
authors.lastname: Nodari
authors.forename: Giovanni
authors.initials: G
authors.lastname: Cancarini
mesh_terms: D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000009:adverse effects; D016572:Cyclosporine / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000139:chemically induced* / Q000188:drug therapy; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D015994:Incidence; D016030:Kidney Transplantation / Q000276:immunology* / Q000401:mortality*; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage* / Q000009:adverse effects; D008875:Middle Aged; D020123:Sirolimus / Q000627:therapeutic use*; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D020123:Sirolimus; D008775:Methylprednisolone