title: Rapid Discontinuation of Prednisone in Kidney Transplant Recipients: 15-Year Outcomes From the University of Minnesota.
abstract: Short- and intermediate-term results have been reported after rapid discontinuation of prednisone (RDP) in kidney transplant recipients. Yet there has been residual concern about late graft failure in the absence of maintenance prednisone.
  
  
  
  From October 1, 1999, through June 1, 2015, we performed a total of 1553 adult first and second kidney transplants-1021 with a living donor, 532 with a deceased donor-under our RDP protocol. We analyzed the 15-year actuarial overall patient survival (PS), graft survival (GS), death-censored GS (DCGS), and acute rejection-free survival (ARFS) rates for RDP compared with historical controls on maintenance prednisone.
  
  
  
  For living donor recipients, the actuarial 15-year PS rates were similar between groups. But RDP was associated with increased GS (P = 0.02) and DCGS (P = 0.01). For deceased donor recipients, RDP was associated with significantly better PS (P < 0.01), GS (P < 0.01) and DCGS (P < 0.01). There was no difference between groups in the rate of acute or chronic rejection, or in the mean estimated glomerular filtration rate at 15 years. However, RDP-treated recipients had significantly lower rates of avascular necrosis, cytomegalovirus, cataracts, new-onset diabetes after transplant, and cardiac complications. Importantly, for recipients with GS longer than 5 years, there was no difference between groups in subsequent actuarial PS, GS, and DCGS.
  
  
  
  In summary, at 15 years postkidney transplant, RDP did not lead to decreased in PS or GS, or an increase in graft dysfunction but as associated with reduced complication rates.
authors.affiliation: 1 Division of Transplantation, Department of Surgery, University of Minnesota, Minneapolis, MN. 2 Division of Renal Diseases and Hypertension, Department of Medicine, University of Minnesota, Minneapolis, MN.
authors.forename: Oscar Kenneth
authors.initials: OK
authors.lastname: Serrano
authors.forename: Raja
authors.initials: R
authors.lastname: Kandaswamy
authors.forename: Kristen
authors.initials: K
authors.lastname: Gillingham
authors.forename: Srinath
authors.initials: S
authors.lastname: Chinnakotla
authors.forename: Ty B
authors.initials: TB
authors.lastname: Dunn
authors.forename: Erik
authors.initials: E
authors.lastname: Finger
authors.forename: William
authors.initials: W
authors.lastname: Payne
authors.forename: Hassan
authors.initials: H
authors.lastname: Ibrahim
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Kukla
authors.forename: Richard
authors.initials: R
authors.lastname: Spong
authors.forename: Naim
authors.initials: N
authors.lastname: Issa
authors.forename: Timothy L
authors.initials: TL
authors.lastname: Pruett
authors.forename: Arthur
authors.initials: A
authors.lastname: Matas
mesh_terms: D000328:Adult; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D005938:Glucocorticoids / Q000627:therapeutic use; D006084:Graft Rejection / Q000188:drug therapy* / Q000401:mortality; D006085:Graft Survival / Q000187:drug effects*; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D011241:Prednisone / Q000627:therapeutic use*; D015996:Survival Rate / Q000639:trends; D014019:Tissue Donors; D066027:Transplant Recipients; D028761:Withholding Treatment
chemical_list: D005938:Glucocorticoids; D011241:Prednisone