title: Ten-year outcome after rapid discontinuation of prednisone in adult primary kidney transplantation.
abstract: OBJECTIVE
  Rapid discontinuation of prednisone after kidney transplantation potentially allows for minimization of steroid-related side effects. Although intermediate-term data with rapid discontinuation of prednisone have been promising, concern still exists regarding long-term outcomes. The 10-year experience is reported herein.
  
  
  METHODS
  Between October 1, 1999 and December 31, 2010, 1241 adult primary kidney transplants (791 living donor and 450 deceased donor) were performed using a protocol in which prednisone is discontinued after postoperative day 5. The 10-year actuarial recipient and graft survival rates and prednisone-related side effects were studied.
  
  
  RESULTS
  Ten-year actuarial patient survival was 71% for living donor transplants and 62% for deceased donor transplants; 10-year graft survival was 61% for living donor transplants and 51% for deceased donor transplants, and was comparable to 10-year Scientific Registry of Transplant Recipients national data. Ten-year death-censored graft survival was 79% for living donor transplants and 80% for deceased donor transplants. Ten-year acute rejection rates were 25% for deceased donor transplants and 31% for living donor transplants; 10-year chronic rejection (interstitial fibrosis/tubular atrophy) rates were 39% for deceased donor transplants and 47% for living donor transplants. For nondiabetic recipients of living donor or deceased donor allografts, the incidence of new-onset diabetes was significantly lower than in historical controls on prednisone (P<0.001). We also found significantly reduced rates of cataracts, avascular necrosis, and cytomegalovirus infection in some subgroups.
  
  
  CONCLUSIONS
  Prednisone-related side effects can be minimized in a protocol incorporating rapid discontinuation of prednisone for maintenance immunosuppression. Ten-year patient and graft outcomes remain acceptable.
authors.affiliation: Department of Surgery, Division of Transplantation, University of Minnesota, Minneapolis, 55455, USA.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Rizzari
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Suszynski
authors.forename: Kristen J
authors.initials: KJ
authors.lastname: Gillingham
authors.forename: Ty B
authors.initials: TB
authors.lastname: Dunn
authors.forename: Hassan N
authors.initials: HN
authors.lastname: Ibrahim
authors.forename: William D
authors.initials: WD
authors.lastname: Payne
authors.forename: Srinath
authors.initials: S
authors.lastname: Chinnakotla
authors.forename: Erik B
authors.initials: EB
authors.lastname: Finger
authors.forename: David E R
authors.initials: DE
authors.lastname: Sutherland
authors.forename: Raja
authors.initials: R
authors.lastname: Kandaswamy
authors.forename: John S
authors.initials: JS
authors.lastname: Najarian
authors.forename: Timothy L
authors.initials: TL
authors.lastname: Pruett
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Kukla
authors.forename: Richard
authors.initials: R
authors.lastname: Spong
authors.forename: Arthur J
authors.initials: AJ
authors.lastname: Matas
mesh_terms: D000328:Adult; D004334:Drug Administration Schedule; D005260:Female; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control*; D006085:Graft Survival / Q000187:drug effects*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000009:adverse effects / Q000276:immunology / Q000401:mortality; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D011241:Prednisone / Q000008:administration & dosage* / Q000009:adverse effects; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D011241:Prednisone