Steroid avoidance in renal transplantation using basiliximab induction, cyclosporine-based immunosuppression and protocol biopsies

Mysore S. Anil Kumar, Sheng Guang Xiao, Billie Fyfe, Debra Sierka, Michael Heifets, Michael J. Moritz, Muhammad I. Saeed, Aparna Kumar

Research output: Contribution to journalArticle

48 Scopus citations

Abstract

Background: Reducing chronic steroid exposure is important to minimize steroid-related morbidity, particularly for susceptible renal transplant recipients. Steroid-free and steroid-sparing protocols have shown benefits, but safety has not been established for all populations. We investigated the safety of steroid avoidance (SA) in a population including African-Americans, using modern immunosuppression with protocol biopsy monitoring. Methods: A randomized-controlled SA trial (early discontinuation, days 2-7) was conducted in a population (n = 77) including African-Americans and cadaveric kidney recipients. Patients received basiliximab, cyclosporine (CsA), and mycophenolate mofetil (MMF). In controls, steroids were tapered to 5 mg prednisone/d by day 30. Protocol biopsies were performed (1, 6, 12 and 24 months) to evaluate subclinical acute rejection (SCAR) and chronic allograft nephropathy (CAN). Results: The SA did not result in significantly higher incidences of graft loss, AR, SCAR, CAN, or renal fibrosis. SA patients experienced similar renal function, comparable serum lipid levels, and a trend toward fewer cases of new-onset diabetes. Clinical outcomes of African-American and non-African-American patients did not significantly differ. Conclusions: The SA is safe in the context of basiliximab induction and CsA-based immunosuppression. This protocol could minimize steroid-related side effects in susceptible groups, including African-Americans, without increasing the risk of AR or graft failure.

Original languageEnglish (US)
Pages (from-to)61-69
Number of pages9
JournalClinical Transplantation
Volume19
Issue number1
DOIs
StatePublished - Feb 1 2005
Externally publishedYes

Keywords

  • African-American
  • Cadaveric organs
  • Kidney transplantation
  • Post transplantation diabetes
  • Protocol biopsy
  • Simulect

ASJC Scopus subject areas

  • Transplantation

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