title: Recurrent glomerulonephritis under rapid discontinuation of steroids.
abstract: BACKGROUND
  Recurrent glomerulonephritis (GN) remains an important cause of kidney allograft loss and whether rapid discontinuation of steroids (RDS) is associated with a higher risk of recurrence is not known.
  
  
  METHODS
  We studied recurrence rate, and graft and patient survival in four groups of recipients: 216 recipients with GN transplanted under RDS (group 1), 978 concurrent non-GN recipients transplanted under RDS (group 2), 260 historic comparator group transplanted for GN between 1994 and 1999 with steroid maintenance (group 3), and 950 recipients who were also transplanted between 1994 and 1999 for non-GN and also maintained on steroids (group 4). Regression analysis adjusting for donor and recipient factors, steroid and sirolimus use, and also GN type was used to address factors associated with recurrent disease.
  
  
  RESULTS
  The 1-, 5-, and 7-year recurrence rate in the GN group under RDS was 6.7%, 13.7%, and 19.2% and in historic GN recipients maintained on steroids it was 2.4%, 3.8%, and 5.3%, respectively (P<0.0001). RDS was associated with a higher adjusted risk of recurrent disease for all GN types (hazard ratio 4.86; 95% confidence interval 2.34-10.07; P<0.0001). Graft and patient survival were similar in the two GN groups and both were highest among all groups. Notably, death-censored graft survival was not different among the groups.
  
  
  CONCLUSIONS
  Steroid avoidance may be associated with a higher rate of recurrent GN but no apparent increase in risk of graft loss. This group of recipients needs to be studied more carefully, in larger numbers, and for a longer time period.
authors.affiliation: Division of Renal Diseases and Hypertension, University of Minnesota, Minneapolis, MN 55414, USA.
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Kukla
authors.forename: Eric
authors.initials: E
authors.lastname: Chen
authors.forename: Richard
authors.initials: R
authors.lastname: Spong
authors.forename: Marc
authors.initials: M
authors.lastname: Weber
authors.forename: Yasser
authors.initials: Y
authors.lastname: El-Shahawi
authors.forename: Kristen
authors.initials: K
authors.lastname: Gillingham
authors.forename: Arthur J
authors.initials: AJ
authors.lastname: Matas
authors.forename: Hassan N
authors.initials: HN
authors.lastname: Ibrahim
mesh_terms: D000328:Adult; D005260:Female; D005921:Glomerulonephritis / Q000209:etiology* / Q000401:mortality; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000379:methods; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D051437:Renal Insufficiency / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D012306:Risk; D013256:Steroids / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D013256:Steroids