title: The effects of early rapid corticosteroid reduction on cell-mediated immunity in kidney transplant recipients.
abstract: While being helpful in the prevention and treatment of acute rejection (AR) in kidney transplant patients, corticosteroids have many side effects associated with their long-term use. It is reasonable to minimize these adverse effects without affecting their benefits. In this prospective trial, we investigated the effects of early rapid corticosteroid reduction on the cell-mediated immunity, measured by the Cylex® Immune Cell Function Assay, the incidence of AR and infection and the allograft function after kidney transplantation to assess the feasibility of this strategy in the Chinese population. A method of rapid reduction of corticosteroid to 10 mg/day seven days post-transplantation was adopted for the experimental group, and the standard corticosteroid therapy for the control group. Comparison of intracellular ATP values detected two weeks post-transplantation for the control group (324±45 ng/mL) and the experimental group (345±91 ng/mL) did not reveal a significant difference (p>0.05). The incidence of AR was analogous between groups (p>0.05), while an increased incidence of infection was observed in the control group (53%) versus the experimental group (22%), where p<0.05. The mean ATP concentration was lower in the control group (235±35 ng/mL) than that of the experimental group (286±16 ng/mL) when infection occurred (p<0.05). The mean allograft function was similar between groups (p>0.05). Rapid corticosteroid reduction early after kidney transplantation does not cause a significant rise in patient immunity or increase the incidence of AR, and contributes to infection control. This strategy may serve as a safe and effective therapy for kidney transplant patients in the Chinese population.
authors.affiliation: Department of Urology, Beijing Chaoyang Hospital of Capital Medical University, No. 8 GongTi Nanlu, Chaoyang District, Beijing 100020, China.
authors.forename: Shihai
authors.initials: S
authors.lastname: Li
authors.forename: Wei
authors.initials: W
authors.lastname: Wang
authors.forename: Xiaopeng
authors.initials: X
authors.lastname: Hu
authors.forename: Liang
authors.initials: L
authors.lastname: Ren
authors.forename: Hang
authors.initials: H
authors.lastname: Yin
authors.forename: Xiaoyong
authors.initials: X
authors.lastname: Yang
authors.forename: Hang
authors.initials: H
authors.lastname: Liu
authors.forename: Xiaodong
authors.initials: X
authors.lastname: Zhang
mesh_terms: D000255:Adenosine Triphosphate / Q000378:metabolism; D000328:Adult; D000911:Antibodies, Monoclonal / Q000008:administration & dosage; D000961:Antilymphocyte Serum / Q000008:administration & dosage; D000077552:Basiliximab; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control; D006801:Humans; D007111:Immunity, Cellular; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D016030:Kidney Transplantation / Q000276:immunology*; D008775:Methylprednisolone / Q000008:administration & dosage*; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives; D011993:Recombinant Fusion Proteins / Q000008:administration & dosage; D016559:Tacrolimus / Q000008:administration & dosage
chemical_list: D000911:Antibodies, Monoclonal; D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents; D011993:Recombinant Fusion Proteins; D000255:Adenosine Triphosphate; D000077552:Basiliximab; D009173:Mycophenolic Acid; D016559:Tacrolimus; D008775:Methylprednisolone