Safety and efficacy of steroid withdrawal two days after kidney transplantation

Analysis of results at three years

Mysore S. Anil Kumar, Michael Heifets, Michael J. Moritz, Muhammad Irfan Saeed, Shahid M. Khan, Billie Fyfe, Nedjema Sustento-Riodeca, Joshua N. Daniel, Aparna Kumar

Research output: Contribution to journalArticle

66 Citations (Scopus)

Abstract

Background. Chronic steroid therapy in spite of myriad side effects is widely used in kidney transplantation. This prospective controlled study evaluated safety and efficacy of steroid withdrawal at 2 days in kidney recipients monitored by surveillance biopsy. Methods. In all, 300 kidney recipients were studied; 150 in second-day steroid withdrawal group and 150 in steroid treated group (control group). Immunosuppression was basiliximab induction and maintenance was a calcineurin inhibitor and mycophenolate mofetil or sirolimus. Biopsy-proven acute rejection (BPAR) was treated by methylpredisolone. Surveillance biopsies were completed to evaluate subclinical acute rejection (SCAR) and chronic allograft nephropathy (CAN). Primary end point was acute rejection. Three-year patient and graft survival, new onset diabetes mellitus (NODM), serum creatinine and creatinine clearance were evaluated. Results. Acute rejection was diagnosed in 14% in control group and 16% in steroid withdrawal group. Three-year patient and graft survival was 89% and 79% in control and 91 % and 78% in steroid withdrawal group. Serum creatinine and creatinine clearance was 1.9±0.8 and 59±11 in control group and 1.8±0.9 mg/dl and 61±10 mis/minute in steroid withdrawal group. Incidence of SCAR and progression of CAN were comparable in the 2 groups. At 3-years NODM was diagnosed in 21% in control group and 4% in steroid withdrawal group (P<0.01). Conclusions. Two-day steroid withdrawal in kidney transplant recipients did not affect BPAR, SCAR, CAN, graft function and patient and graft survival compared to control group up to 3 years. NODM was significantly less in steroid withdrawal group. Two-day steroid withdrawal is safe and beneficial in kidney transplant recipients.

Original languageEnglish (US)
Pages (from-to)832-839
Number of pages8
JournalTransplantation
Volume81
Issue number6
DOIs
StatePublished - Mar 1 2006
Externally publishedYes

Fingerprint

Kidney Transplantation
Steroids
Safety
Creatinine
Graft Survival
Control Groups
Allografts
Kidney
Biopsy
Diabetes Mellitus
Mycophenolic Acid
Sirolimus
Serum
Immunosuppression
Maintenance
Prospective Studies
Transplants
Incidence

Keywords

  • Kidney transplant
  • Surveillance biopsy
  • Two-day steroid withdrawal

ASJC Scopus subject areas

  • Transplantation

Cite this

Safety and efficacy of steroid withdrawal two days after kidney transplantation : Analysis of results at three years. / Anil Kumar, Mysore S.; Heifets, Michael; Moritz, Michael J.; Saeed, Muhammad Irfan; Khan, Shahid M.; Fyfe, Billie; Sustento-Riodeca, Nedjema; Daniel, Joshua N.; Kumar, Aparna.

In: Transplantation, Vol. 81, No. 6, 01.03.2006, p. 832-839.

Research output: Contribution to journalArticle

Anil Kumar, MS, Heifets, M, Moritz, MJ, Saeed, MI, Khan, SM, Fyfe, B, Sustento-Riodeca, N, Daniel, JN & Kumar, A 2006, 'Safety and efficacy of steroid withdrawal two days after kidney transplantation: Analysis of results at three years', Transplantation, vol. 81, no. 6, pp. 832-839. https://doi.org/10.1097/01.tp.0000203558.34739.c6
Anil Kumar, Mysore S. ; Heifets, Michael ; Moritz, Michael J. ; Saeed, Muhammad Irfan ; Khan, Shahid M. ; Fyfe, Billie ; Sustento-Riodeca, Nedjema ; Daniel, Joshua N. ; Kumar, Aparna. / Safety and efficacy of steroid withdrawal two days after kidney transplantation : Analysis of results at three years. In: Transplantation. 2006 ; Vol. 81, No. 6. pp. 832-839.
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abstract = "Background. Chronic steroid therapy in spite of myriad side effects is widely used in kidney transplantation. This prospective controlled study evaluated safety and efficacy of steroid withdrawal at 2 days in kidney recipients monitored by surveillance biopsy. Methods. In all, 300 kidney recipients were studied; 150 in second-day steroid withdrawal group and 150 in steroid treated group (control group). Immunosuppression was basiliximab induction and maintenance was a calcineurin inhibitor and mycophenolate mofetil or sirolimus. Biopsy-proven acute rejection (BPAR) was treated by methylpredisolone. Surveillance biopsies were completed to evaluate subclinical acute rejection (SCAR) and chronic allograft nephropathy (CAN). Primary end point was acute rejection. Three-year patient and graft survival, new onset diabetes mellitus (NODM), serum creatinine and creatinine clearance were evaluated. Results. Acute rejection was diagnosed in 14{\%} in control group and 16{\%} in steroid withdrawal group. Three-year patient and graft survival was 89{\%} and 79{\%} in control and 91 {\%} and 78{\%} in steroid withdrawal group. Serum creatinine and creatinine clearance was 1.9±0.8 and 59±11 in control group and 1.8±0.9 mg/dl and 61±10 mis/minute in steroid withdrawal group. Incidence of SCAR and progression of CAN were comparable in the 2 groups. At 3-years NODM was diagnosed in 21{\%} in control group and 4{\%} in steroid withdrawal group (P<0.01). Conclusions. Two-day steroid withdrawal in kidney transplant recipients did not affect BPAR, SCAR, CAN, graft function and patient and graft survival compared to control group up to 3 years. NODM was significantly less in steroid withdrawal group. Two-day steroid withdrawal is safe and beneficial in kidney transplant recipients.",
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T1 - Safety and efficacy of steroid withdrawal two days after kidney transplantation

T2 - Analysis of results at three years

AU - Anil Kumar, Mysore S.

AU - Heifets, Michael

AU - Moritz, Michael J.

AU - Saeed, Muhammad Irfan

AU - Khan, Shahid M.

AU - Fyfe, Billie

AU - Sustento-Riodeca, Nedjema

AU - Daniel, Joshua N.

AU - Kumar, Aparna

PY - 2006/3/1

Y1 - 2006/3/1

N2 - Background. Chronic steroid therapy in spite of myriad side effects is widely used in kidney transplantation. This prospective controlled study evaluated safety and efficacy of steroid withdrawal at 2 days in kidney recipients monitored by surveillance biopsy. Methods. In all, 300 kidney recipients were studied; 150 in second-day steroid withdrawal group and 150 in steroid treated group (control group). Immunosuppression was basiliximab induction and maintenance was a calcineurin inhibitor and mycophenolate mofetil or sirolimus. Biopsy-proven acute rejection (BPAR) was treated by methylpredisolone. Surveillance biopsies were completed to evaluate subclinical acute rejection (SCAR) and chronic allograft nephropathy (CAN). Primary end point was acute rejection. Three-year patient and graft survival, new onset diabetes mellitus (NODM), serum creatinine and creatinine clearance were evaluated. Results. Acute rejection was diagnosed in 14% in control group and 16% in steroid withdrawal group. Three-year patient and graft survival was 89% and 79% in control and 91 % and 78% in steroid withdrawal group. Serum creatinine and creatinine clearance was 1.9±0.8 and 59±11 in control group and 1.8±0.9 mg/dl and 61±10 mis/minute in steroid withdrawal group. Incidence of SCAR and progression of CAN were comparable in the 2 groups. At 3-years NODM was diagnosed in 21% in control group and 4% in steroid withdrawal group (P<0.01). Conclusions. Two-day steroid withdrawal in kidney transplant recipients did not affect BPAR, SCAR, CAN, graft function and patient and graft survival compared to control group up to 3 years. NODM was significantly less in steroid withdrawal group. Two-day steroid withdrawal is safe and beneficial in kidney transplant recipients.

AB - Background. Chronic steroid therapy in spite of myriad side effects is widely used in kidney transplantation. This prospective controlled study evaluated safety and efficacy of steroid withdrawal at 2 days in kidney recipients monitored by surveillance biopsy. Methods. In all, 300 kidney recipients were studied; 150 in second-day steroid withdrawal group and 150 in steroid treated group (control group). Immunosuppression was basiliximab induction and maintenance was a calcineurin inhibitor and mycophenolate mofetil or sirolimus. Biopsy-proven acute rejection (BPAR) was treated by methylpredisolone. Surveillance biopsies were completed to evaluate subclinical acute rejection (SCAR) and chronic allograft nephropathy (CAN). Primary end point was acute rejection. Three-year patient and graft survival, new onset diabetes mellitus (NODM), serum creatinine and creatinine clearance were evaluated. Results. Acute rejection was diagnosed in 14% in control group and 16% in steroid withdrawal group. Three-year patient and graft survival was 89% and 79% in control and 91 % and 78% in steroid withdrawal group. Serum creatinine and creatinine clearance was 1.9±0.8 and 59±11 in control group and 1.8±0.9 mg/dl and 61±10 mis/minute in steroid withdrawal group. Incidence of SCAR and progression of CAN were comparable in the 2 groups. At 3-years NODM was diagnosed in 21% in control group and 4% in steroid withdrawal group (P<0.01). Conclusions. Two-day steroid withdrawal in kidney transplant recipients did not affect BPAR, SCAR, CAN, graft function and patient and graft survival compared to control group up to 3 years. NODM was significantly less in steroid withdrawal group. Two-day steroid withdrawal is safe and beneficial in kidney transplant recipients.

KW - Kidney transplant

KW - Surveillance biopsy

KW - Two-day steroid withdrawal

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