title: Early corticosteroid withdrawal regimen in a living donor kidney transplantation program.
abstract: Steroids have been the essential component of transplant immunosuppression. Recently, with availability of better immunosuppressive agents, many centers have started steroid free transplant with good success rates. We analyzed the outcomes of early corticosteroid withdrawal (CSW) protocol in our living donor kidney transplant programme. We included 73 patients on CSW protocol on basiliximab + tacrolimus and mycophenolate mofetil and compared them with 67 recipients on similar regimen with corticosteroids (CSs). CSW group received prednisolone 40 mg on day 1, which was stopped on day 5. Outcomes were evaluated in terms of acute rejection (AR), infections, new onset diabetes after transplant (NODAT), renal function and graft or patient loss. In CSW group, 15/73 (20.5%) patients developed AR, when compared to 5/67 (7.5%) in CS group, (P = 0.02). Biopsy proven acute rejection was seen in 12/72 (16.6%) in CSW group and 5/67 (7.5%) in CS (P = 0.1). One patient in CSW group developed antibody mediated rejection. NODAT was similar (9% in CS vs. 3.7% in CSW, P = 0.09), but infections were higher in CSW group (20.5% vs. 7.5%, P = 0.02). Mean serum creatinine was similar at 6 months (1.24 ± 0.6 in CS and 1.25 ± 0.3 in CSW, P = 0.9). Graft survival was 100% and 97% (P = 0.1) and patient survival was 98.6% and 98.5% (P = 0.9) in CSW and CS groups. Early corticosteroid withdrawal with basiliximab induction was associated with increased risk of AR but did not have any effect on short term graft and pateint survival.
authors.affiliation: Department of Nephrology, Medanta Kidney and Urology Institute, Medanta Medicity, Gurgaon, Haryana, India.
authors.forename: S B
authors.initials: SB
authors.lastname: Bansal
authors.affiliation: Department of Nephrology, Medanta Kidney and Urology Institute, Medanta Medicity, Gurgaon, Haryana, India.
authors.forename: S
authors.initials: S
authors.lastname: Sethi
authors.affiliation: Department of Nephrology, Medanta Kidney and Urology Institute, Medanta Medicity, Gurgaon, Haryana, India.
authors.forename: R
authors.initials: R
authors.lastname: Sharma
authors.affiliation: Department of Nephrology, Medanta Kidney and Urology Institute, Medanta Medicity, Gurgaon, Haryana, India.
authors.forename: M
authors.initials: M
authors.lastname: Jain
authors.affiliation: Department of Nephrology, Medanta Kidney and Urology Institute, Medanta Medicity, Gurgaon, Haryana, India.
authors.forename: P
authors.initials: P
authors.lastname: Jha
authors.affiliation: Department of Urology, Medanta Kidney and Urology Institute, Medanta Medicity, Gurgaon, Haryana, India.
authors.forename: R
authors.initials: R
authors.lastname: Ahlawat
authors.affiliation: Department of Lab Medicine, Medanta Kidney and Urology Institute, Medanta Medicity, Gurgaon, Haryana, India.
authors.forename: R
authors.initials: R
authors.lastname: Duggal
authors.affiliation: Department of Urology, Medanta Kidney and Urology Institute, Medanta Medicity, Gurgaon, Haryana, India.
authors.forename: V
authors.initials: V
authors.lastname: Kher
keywords: Steroid free; kidney transplantation; living donors
references.citation: Transplantation. 2005 Dec 27;80(12):1734-41
references.pmid: 16378069
references.citation: Am J Transplant. 2001 Sep;1(3):278-83
references.pmid: 12102262
references.citation: Transplantation. 2003 Jan 27;75(2):204-8
references.pmid: 12548124
references.citation: Transplantation. 2006 Jul 15;82(1):55-61
references.pmid: 16861942
references.citation: J Am Soc Nephrol. 1993 Dec;4(6):1300-5
references.pmid: 8130356
references.citation: Am J Transplant. 2004 May;4(5):803-10
references.pmid: 15084178
references.citation: Transplantation. 1998 Nov 15;66(9):1207-10
references.pmid: 9825819
references.citation: Ann Surg. 2008 Oct;248(4):564-77
references.pmid: 18936569
references.citation: Am J Transplant. 2009 Dec;9(12):2768-76
references.pmid: 19845594
references.citation: BioDrugs. 2001;15(4):261-78
references.pmid: 11437691
references.citation: Am J Transplant. 2005 Jan;5(1):157-66
references.pmid: 15636625
references.citation: Transplantation. 2013 Feb 27;95(4):573-9
references.pmid: 23423269
references.citation: Clin Transplant. 2007 Jan-Feb;21(1):101-9
references.pmid: 17302598
references.citation: CMAJ. 1992 Sep 1;147(5):645-57
references.pmid: 1521210
references.citation: Transplantation. 2012 Apr 27;93(8):799-805
references.pmid: 22290269
references.citation: Transplantation. 1996 Apr 15;61(7):1029-37
references.pmid: 8623181
references.citation: Ann Surg. 2004 Sep;240(3):510-6; discussion 516-7
references.pmid: 15319722
references.citation: J Am Soc Nephrol. 2000 Oct;11(10):1910-1917
references.pmid: 11004223
references.citation: Transplantation. 2005 Apr 15;79(7):807-14
references.pmid: 15818323
references.citation: Clin Exp Rheumatol. 1991 Jan-Feb;9 Suppl 6:19-20
references.pmid: 2060172
references.citation: Am J Transplant. 2008 Feb;8(2):307-16
references.pmid: 18211506
references.citation: Transplantation. 2010 Jan 15;89(1):1-14
references.pmid: 20061913
references.citation: Am J Transplant. 2003 Mar;3(3):306-11
references.pmid: 12614286
references.citation: Am J Med. 1994 Feb;96(2):115-23
references.pmid: 8109596
references.citation: Transplantation. 2004 Nov 27;78(10):1548-56
references.pmid: 15599321
references.citation: Arthritis Rheum. 2006 Jun 15;55(3):420-6
references.pmid: 16739208