title: Discontinuation of steroids in ABO-incompatible renal transplantation.
abstract: A steroid-free protocol for ABO-compatible renal transplantation has been used at our center since 1983. To minimize the adverse effects of steroids, we also developed a steroid sparing protocol for ABO-incompatible renal transplantation in 2008. The present study is a report of our results. A retrospective review of the first 50 ABO-incompatible renal transplantations performed at a single university center. If no immunological events occurred in the post-transplant period, prednisolone tapering was initiated approximately 3 months after transplantation. Forty-three patients completed prednisolone tapering after 289 ± 58 days. Three patients died during follow-up, and four patients lost graft function. None of these adverse events were rejection related. Eleven patients experienced rejections; seven were on prednisolone and four were after weaning from prednisolone. All patients responded well to antirejection treatment. Overall, 1-year rejection rate was 19%. One- and 3-year graft survival was 94% and 91%, respectively. One-year post-transplant median serum creatinine was 123 μmol/L. We found acceptable rejection rates, graft survival, and creatinine levels in patients undergoing ABO-incompatible renal transplantations with a steroid sparing protocol. However, a longer follow-up of a lager cohort is needed before firm conclusions can be made.
authors.affiliation: Division of Nephrology, Department of Medicine, Fredericia Hospital - Part of Lillebaelt Hospital, Fredericia, Denmark.|Department of Nephrology, Odense University Hospital, Odense, Denmark.
authors.forename: Marija Kristina
authors.initials: MK
authors.lastname: Novosel
authors.affiliation: Department of Nephrology, Odense University Hospital, Odense, Denmark.
authors.forename: Claus
authors.initials: C
authors.lastname: Bistrup
mesh_terms: D000017:ABO Blood-Group System; D000328:Adult; D000368:Aged; D000906:Antibodies / Q000097:blood; D001706:Biopsy; D001787:Blood Group Incompatibility; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011239:Prednisolone / Q000008:administration & dosage / Q000627:therapeutic use; D051437:Renal Insufficiency / Q000097:blood* / Q000601:surgery*; D012189:Retrospective Studies; D013256:Steroids / Q000008:administration & dosage* / Q000009:adverse effects; D016559:Tacrolimus / Q000008:administration & dosage; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000017:ABO Blood-Group System; D000906:Antibodies; D007166:Immunosuppressive Agents; D013256:Steroids; D011239:Prednisolone; D016559:Tacrolimus
keywords: ABO incompatibility; kidney transplantation; prednisolone sparing; renal transplantation; steroid sparing; steroid withdrawal