Intermediate-term outcomes with early steroid withdrawal in African-American renal transplant recipients undergoing surveillance biopsy

Xu, Zhuo; El-Amm, Jose M.; Doshi, Mona D.; Singh, Atul Kumar; Morawski, Katherina; Cincotta, Elizabeth; Losanoff, Julian E.; West, Michael O.; Gruber, Scott A.

doi:10.1016/j.surg.2007.07.006

Cited by 21 publications

(15 citation statements)

References 23 publications

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“…Second, most recipients in our study were Caucasian, with only a small proportion of African Americans. Although successful short-term outcome has been reported for African Americans on RDP (31)(32)(33)(34), additional studies with larger numbers and longer follow-up need to be done. Third, we have not done protocol biopsies.…”

Section: Discussionmentioning

confidence: 99%

Ten-Year Outcome after Rapid Discontinuation of Prednisone in Adult Primary Kidney Transplantation

Rizzari¹,

Suszynski²,

Gillingham³

et al. 2012

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Rapid discontinuation of prednisone after kidney transplantation potentially allows for minimization of steroid-related side effects. Although intermediate-term data with rapid discontinuation of prednisone have been promising, concern still exists regarding long-term outcomes. The 10-year experience is reported herein.Design, setting, participants, & measurements Between October 1, 1999 and December 31, 2010, 1241 adult primary kidney transplants (791 living donor and 450 deceased donor) were performed using a protocol in which prednisone is discontinued after postoperative day 5. The 10-year actuarial recipient and graft survival rates and prednisone-related side effects were studied.Results Ten-year actuarial patient survival was 71% for living donor transplants and 62% for deceased donor transplants; 10-year graft survival was 61% for living donor transplants and 51% for deceased donor transplants, and was comparable to 10-year Scientific Registry of Transplant Recipients national data. Ten-year deathcensored graft survival was 79% for living donor transplants and 80% for deceased donor transplants. Ten-year acute rejection rates were 25% for deceased donor transplants and 31% for living donor transplants; 10-year chronic rejection (interstitial fibrosis/tubular atrophy) rates were 39% for deceased donor transplants and 47% for living donor transplants. For nondiabetic recipients of living donor or deceased donor allografts, the incidence of new-onset diabetes was significantly lower than in historical controls on prednisone (P,0.001). We also found significantly reduced rates of cataracts, avascular necrosis, and cytomegalovirus infection in some subgroups.Conclusions Prednisone-related side effects can be minimized in a protocol incorporating rapid discontinuation of prednisone for maintenance immunosuppression. Ten-year patient and graft outcomes remain acceptable.

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Section: Discussionmentioning

confidence: 99%

Ten-Year Outcome after Rapid Discontinuation of Prednisone in Adult Primary Kidney Transplantation

Rizzari¹,

Suszynski²,

Gillingham³

et al. 2012

Clinical Journal of the American Society of Nephrology

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“…high immunological risk studies, the AR rates were moderate at 13-14% with a remarkably improved graft and patient survival being recorded. However, there is still need for further verifi cation on the consistence of this type of management protocol [44][45][46][47].…”

Section: Low Steroid Dose Maintenancementioning

confidence: 99%

Defining a Steroid Withdrawal Protocol in a newly established Kidney Transplantation Unit

Halawa¹

2017

Arch Organ Transplant

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“…They refer to their 1-year report of an uncontrolled study in 57 AA recipients with ESW treated with Thymoglobulin induction (6). Doshi and colleagues also state that basiliximab is not effective in the prevention of SCAR in AA recipients with ESW.…”

Section: To the Editormentioning

confidence: 99%

“…Doshi and colleagues also state that basiliximab is not effective in the prevention of SCAR in AA recipients with ESW. They refer to their 1-year report of an uncontrolled study in 57 AA recipients with ESW treated with Thymoglobulin induction (6). In their report less than 50% of recipients had surveillance biopsies at 1, 6 and 12 months and none beyond 1 year and based on this finding they concluded that Thymoglobulin induction is more effective for prevention of SCAR in AA recipients with ESW (6).…”

Section: To the Editormentioning

confidence: 99%

Chronic Steroid Therapy Versus Steroid Withdrawal Plus Pulse Steroid Therapy for Rejection in Kidney Recipients with Basiliximab Therapy

Kumar

Ranganna

Malat

2008

American Journal of Transplantation

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We appreciate the comments by Drs. Doshi, El-Amm and Gruber referring to our early steroid withdrawal (ESW) protocol (1,2). They state that in our study, 1-year steroid exposure far exceeds in recipients with ESW receiving pulse steroid therapy for clinical and subclinical acute rejections (SCAR) compared to recipients with chronic steroid therapy without rejections (1,2). Short course of intravenous pharmacological pulse doses of steroids is effective for the treatment of inflammation of acute rejection and has fewer long-term side effects compared to either low-dose or high-dose chronic steroid therapy (3)(4)(5). In our ESW study, the steroid exposure in African American (AA) recipients with rejections was limited to pulse therapy and avoided chronic steroid exposure in all patients thus reducing long-term steroid complications. The total dose exposure may be similar in the first year but the incidence of long-term side effects such as new onset diabetes mellitus (NODM) and increase in body mass index at 1, 3 and 5 years were significantly lower in ESW group with or without rejections compared to chronic low-dose steroid group (1,2). As per our protocol, all clinical acute rejections and Banff grade 1A or higher SCAR were treated (1). At 1, 2, 3, 4 and 5 years posttransplant the mean per patient cumulative dose of steroids in ESW recipients without rejections was 375, 375, 375, 375 and 375 mg, in ESW recipients with clinical and SCAR (some recipients had more than one rejection episode during 5-year period) 2375, 2550, 2625, 2750 and 2800 mg and in recipients maintained on chronic steroid therapy and without rejections was 1975, 3950, 5750, 7550 and 9350 mg, respectively (1,2). The cumulative steroid dose at 4 and 5 years in recipients with chronic steroid therapy is unpublished data. The combined incidence of clinical and SCAR in living donor transplantation in our study was 29% in AA recipients compared to 17% in non-AA recipients. The number of living donors (7 in AA and 17 in non-AA groups) was too small to obtain meaningful statistical significance for the differences in rejection rates. The incidence of NODM was 8.2% in 73 AA recipients at risk; 4 AA recipients without rejections (7.6%) and 2 (9.5%) recipients with pulse steroid therapy for rejection developed NODM from 1 through 5 years. More importantly beyond 2 years posttransplant both cumulative steroid dose and the long-term side effects of steroids in ESW recipients with rejections were significantly lower compared to recipients maintained on chronic steroid therapy without rejection (2). This finding in our study confirms that short intravenous pharmacological pulse steroid treatment differs from chronic steroid therapy in the side-effect profile (3). All ESW recipients in our study with or without clinical and SCAR have remained free of chronic steroid therapy for 5 years or longer. The aim of ESW was to avoid or minimize long-term side effects of steroids without seriously compromising 3-and 5-year outcomes of clinical acute rejections and ...

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Intermediate-term outcomes with early steroid withdrawal in African-American renal transplant recipients undergoing surveillance biopsy

Cited by 21 publications

References 23 publications

Ten-Year Outcome after Rapid Discontinuation of Prednisone in Adult Primary Kidney Transplantation

Ten-Year Outcome after Rapid Discontinuation of Prednisone in Adult Primary Kidney Transplantation

Defining a Steroid Withdrawal Protocol in a newly established Kidney Transplantation Unit

Chronic Steroid Therapy Versus Steroid Withdrawal Plus Pulse Steroid Therapy for Rejection in Kidney Recipients with Basiliximab Therapy

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