title: Early steroid withdrawal results in improved patient and graft survival and lower risk of post-transplant cardiovascular risk profiles: A single-center 10-year experience.
abstract: Long-term use of steroids results in predictable secondary effects that can lead to increased morbidity and mortality. In this study, we present 10 years worth of data of early steroid withdrawal (ESW) immunosuppression consisting of mycophenolate, sirolimus, and tacrolimus. From 2003 to 2013, 563 kidney transplant recipients were weaned off steroids prior to discharge. We compared outcomes with that of our 65 historical controls maintained on steroids. We analyzed graft and patient survival and determined the incidence of steroid-related comorbidities such as hypertension, hypercholesterolemia, diabetes, coronary artery disease, and weight gain. Patients on ESW maintenance immunosuppression had improved patient and graft survival compared to controls. (HR: 0.23; P≤.011, 0.57; P=.026). Rates of biopsy-proven acute rejection were not different among both groups (HR: 1.24; P=.610). Incidence of post-transplant diabetes were reduced but not statistically significant (OR: 0.67; P=.138). Additionally, the development of hypertension (OR: 0.86, P≤.01), hypercholesterolemia (RR: 0.82; P=.027), CAD (RR: 0.43; P=.002), and >20 lbs. weight gain (RR: 0.29; P≤.01) was significantly improved over 10 years following initiation of ESW protocols. Early steroid withdrawal in renal transplant recipients results in improved patient and graft survival as well as better rates of post-transplant comorbid conditions.
authors.affiliation: Division of Surgery, Section of Transplantation, Albany Medical Center, Albany, NY, USA.
authors.forename: Reynold I
authors.initials: RI
authors.lastname: Lopez-Soler
authors.affiliation: Department of Surgery, Albany Medical College, Albany, NY, USA.
authors.forename: Ryan
authors.initials: R
authors.lastname: Chan
authors.affiliation: Department of Surgery, Albany Medical College, Albany, NY, USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: Martinolich
authors.affiliation: Department of Surgery, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Park
authors.affiliation: Department of Surgery, Albany Medical College, Albany, NY, USA.
authors.forename: Ashar
authors.initials: A
authors.lastname: Ata
authors.affiliation: Division of Surgery, Section of Transplantation, Albany Medical Center, Albany, NY, USA.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Chandolias
authors.affiliation: Division of Surgery, Section of Transplantation, Albany Medical Center, Albany, NY, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Conti
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality* / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000209:etiology / Q000401:mortality* / Q000473:pathology; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000601:surgery*; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000009:adverse effects / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality; D011379:Prognosis; D012307:Risk Factors; D013256:Steroids / Q000008:administration & dosage*; D028761:Withholding Treatment
chemical_list: D007166:Immunosuppressive Agents; D013256:Steroids
keywords: early steroid withdrawal; renal transplant; sirolimus; transplant outcomes