Intermediate steroid withdrawal after renal transplantation and anti-HLA antibodies (HLA-Abs) development.
BACKGROUND
Steroid withdrawal in renal transplantation is desirable to avoid their adverse effects. However, by decreasing the immunosuppression, could lead to an increased risk for the development of HLA-Abs.


OBJECTIVE
Evaluate the relationship between steroid withdrawal and development of HLA-Abs in renal transplantation.


METHODS
We analyzed sera by Luminex from 182 kidney transplants performed from 1998 to 2011, before and two years after transplantation. All the patients had a pretransplant PRA (panel reactive of antibodies) <20% by complement-dependent cytotoxicity (CDC) and maintenance immunosuppression with tacrolimus and mycophenolate mofetil (MMF). We compared a group of steroid withdrawal at 7 months (group-I; n=130) and another control with non-withdrawal (group-II; n=52).


RESULTS
22 patients (16.9%) in group-I and 11 patients in group-II (21.1%) had HLA-Abs after two years (pNS). Despite excluding patients with PRA >20%, we detected HLA-Abs pretransplant by Luminex in 11.5% of patients in both groups, of which, 66.6%, versus 53% (p 0.058), developed new specificities, with a similar percentage of donor specific antibodies (DSA) in both groups (33.33% vs 36.36%), pNS. In the subgroup without pretransplant HLA-Abs (group-I; n=115, group-II; n=45), 6.08% developed de novo HLA-Abs, being DSA 3.4% (Group-I) versus 7.69% in group II with 3.84% DSA (pNS).


CONCLUSIONS
Steroid withdrawal at 7 months of renal transplantation does not entail a higher risk in terms of HLA-Abs development in patients without pretransplant HLA-Abs and treatment with tacrolimus and MMF, although larger studies are needed to confirm these findings.
Nephrology Department, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain. Electronic address: elenamonfa@gmail.com.
Elena
E
Monfá
Immunology Department, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain; Histocompatibility Testing Laboratory, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
David
D
San Segundo
Nephrology Department, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain.
Juan Carlos Ruiz
JCR
San Millán
Pharmacology Department, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain.
Judith
J
Sanabria
Nephrology Department, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain.
Zoila
Z
Albines
Nephrology Department, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain.
Emilio
E
Rodrigo
Histocompatibility Testing Laboratory, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
Iñigo
I
Romón
Immunology Department, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain; Histocompatibility Testing Laboratory, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
Esther
E
Asensio
Nephrology Department, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain.
Manuel
M
Arias
Immunology Department, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain; Histocompatibility Testing Laboratory, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
Marcos
M
López-Hoyos
Anti-HLA-antibodies; Anticuerpos anti-HLA; Corticoides; Immunosuppression; Inmunosupresión; Kidney transplantation; Retirada; Steroids; Trasplante renal; Withdrawal