Recipient Age and Mycophenolate Mofetil As the Main Determinants of Outcome after Steroid Withdrawal: Analysis of Long-Term Follow-up in Renal Transplantation

Abstract

The long-term benefit of steroid withdrawal on patient and graft survival is unproven. Steroids were stopped within the first year after kidney transplantation in 223 consecutive low-risk patients initially treated with thymoglobulin and triple-drug therapy. The 15-year actuarial graft survival rate was 83.9%. Risk factors for graft loss were: proteinuria (hazard ratio [HR]: 6.96, P = 0.0003), creatinine >130 micromol/L (HR: 3.37, P = 0.01), recipient age <35 years (HR: 5.31, P = 0.001), and no mycophenolate mofetil (MMF) treatment (HR: 8.83, P = 0.04). Interestingly, recipient age and no MMF treatment were not risk factors in higher-risk patients in whom steroids were continued. The 2-year incidence of acute rejection following steroid withdrawal was 12.1%; the graft survival rate was lower in this group (71.1%). Our findings indicate that late steroid withdrawal results in excellent long-term outcome in most low-risk patients, but it should be attempted with caution in younger patients and when MMF is not used.

Efficacy on Renal Function of Early Conversion from Cyclosporine to Sirolimus 3 Months After Renal Transplantation: Concept Study

“…The role of polyclonal antibodies may also be of importance in this context. Indeed, when polyclonal antithymocyte globulin is used, relative by long-term T-cell depletion is achieved, thus allowing safe steroid withdrawal (26)(27)(28). The use of induction with anti IL-2 R antibodies without long-term Tcell depletion may not allow safe steroid withdrawal in the context of CNI withdrawal.…”

Respective Predictive Role of Urinary Albumin Excretion and Nonalbumin Proteinuria on Graft Loss and Death in Renal Transplant Recipients

“…Most patients received our institution's immunosuppressive regimen: induction therapy with antithymocyte globulin (Thymoglobulin ® , Sangstat, Lyon, France) or interleukin-2-receptor antagonists (Simulect ® , Novartis, Rueil-Malmaison France). Prednisone at 1 mg/kg per day for the first 2 weeks was then progressively decreased and finally withdrawn within the first year after transplantation in patients with low immunological risk (12). The patients were followed up in our institution, and the median followup period after the measurement of UAE was 40.0 months (range: 3.7-99 months).…”

Early Outcomes of Thymoglobulin and Basiliximab Induction in Kidney Transplantation: Application of Statistical Approaches to Reduce Bias in Observational Comparisons

“…Early attempts at steroid avoidance/withdrawal have been associated with unacceptable rates of acute rejection and graft failure (19–21); however, concomitant antibody induction has yielded acceptable results in some samples including low immunologic risk groups, pediatric samples, and patients receiving FK and sirolimus (22–24). Notably, a recent open-label non-inferiority trial comparing 12-month renal function as the primary endpoint among 336 de novo transplant recipients randomized to steroid avoidance, early steroid withdrawal, or “standard-steroids” in the context of basiliximab induction, cyclosporine and MMF found that estimated GFR was highest in the standard-steroids group and did not satisfy the a priori non-inferiority criterion (25).…”