title: Steroid avoidance reduce the cost of morbidities after live-donor renal allotransplants: a prospective, randomized, controlled study.
abstract: OBJECTIVE
  Steroids have had the main role in renal transplant for more than 4 decades. However, chronic use of steroids is associated with many comorbidities, owing to a lack of assessing cost-benefit of steroid avoidance in live-donor renal allotransplants. In this prospective, randomized, controlled study, we aimed to assess the cost-benefit of a steroid-free immunosuppression regimen among Egyptian live-donor renal transplants.
  
  
  METHODS
  One hundred patients were randomly allocated to receive tacrolimus, mycophenolate mofetil, and steroids for only 3 days (n=50 patients; study group) or tacrolimus, mycophenolate mofetil, and steroids on a maintenance basis (n=50 patients; control group). All patients received basiliximab (Simulect) induction, with median follow-up of 12 months.
  
  
  RESULTS
  Both groups showed comparable graft and patient survivals, rejection episodes, and graft functioning. Posttransplant comorbidities were significantly more prevalent in the steroid-maintenance group. Hypertension was detected in 4% of steroid-free group versus 24% in the steroid-maintenance group (P = .0009). Posttransplant diabetes mellitus, serious infections, and hyperlipidemia were significantly more prevalent in the steroid-maintenance group (P < .05). Associated hospitalization costs were 2.2-fold higher in the steroid-maintenance group than they were in the steroid-free group. One year after transplant, the cost of managing posttransplant comorbidities was significantly higher in steroid-maintenance group, despite comparable costs of immunosuppression.
  
  
  CONCLUSIONS
  In low, immunologic risk recipients of live-donor renal transplants, using basiliximab induction and maintenance with tacrolimus, mycophenolate mofetil, steroid avoidance was associated with lower first annual total costs despite comparable immunosuppression costs, which was attributed to lower costs of associated morbidities.
authors: Urology & Nephrology Center, Mansoura, Egypt. ogheith@yahoo.com
authors: Osama A
authors: OA
authors: Gheith
authors: Ahmed H
authors: AH
authors: Nematalla
authors: Mohamed A
authors: MA
authors: Bakr
authors: Ayman
authors: A
authors: Refaie
authors: Ahmed A
authors: AA
authors: Shokeir
authors: Mohamed A
authors: MA
authors: Ghoneim
mesh_terms: D000293:Adolescent; D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D000077552:Basiliximab; D015897:Comorbidity; D000075202:Contraindications; D003362:Cost-Benefit Analysis; D003920:Diabetes Mellitus / Q000191:economics / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology; D006801:Humans; D006949:Hyperlipidemias / Q000191:economics / Q000453:epidemiology* / Q000209:etiology; D006973:Hypertension / Q000191:economics / Q000453:epidemiology* / Q000209:etiology; D007165:Immunosuppression Therapy / Q000191:economics* / Q000379:methods; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D015994:Incidence; D016030:Kidney Transplantation / Q000276:immunology*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D011446:Prospective Studies; D011993:Recombinant Fusion Proteins / Q000627:therapeutic use; D013256:Steroids / Q000009:adverse effects / Q000627:therapeutic use; D016559:Tacrolimus / Q000627:therapeutic use; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000911:Antibodies, Monoclonal; D007166:Immunosuppressive Agents; D011993:Recombinant Fusion Proteins; D013256:Steroids; D000077552:Basiliximab; D009173:Mycophenolic Acid; D016559:Tacrolimus