Outcome at 3 years with a prednisone-free maintenance regimen: A single-center experience with 349 kidney transplant recipients

Authors

Khalid Khwaja, University of Minnesota Twin Cities
Massimo Asolati, University of Minnesota Twin Cities
James Harmon, University of Minnesota Twin Cities
J. Keith Melancon, University of Minnesota Twin Cities
Ty Dunn, University of Minnesota Twin Cities
Kristen Gillingham, University of Minnesota Twin Cities
Raja Kandaswamy, University of Minnesota Twin Cities
Abhinav Humar, University of Minnesota Twin Cities
Rainer Gruessner, University of Minnesota Twin Cities
William Payne, University of Minnesota Twin Cities
John Najarian, University of Minnesota Twin Cities
David Dunn, University of Minnesota Twin Cities
David Sutherland, University of Minnesota Twin Cities
Arthur J. Matas, University of Minnesota Twin Cities

Document Type

Journal Article

Publication Date

6-1-2004

Journal

American Journal of Transplantation

Volume

4

Issue

6

DOI

10.1111/j.1600-6143.2004.00443.x

Keywords

Kidney transplant; Steroid-free

Abstract

Historically, late steroid withdrawal after kidney transplants has been associated with an increased rejection rate. Recently, low rejection rates have been reported for recipients treated with complete avoidance or rapid elimination of steroids. However, follow-up has been short. We herein report on 3-year outcome in recipients whose prednisone was rapidly eliminated and who were maintained on a steroid-free regimen. From 10/1/1999 through 5/1/2003, 349 recipients (254 LD, 95 CAD; 319 in first 30 s) were immunosuppressed with polyclonal antibody (Thymoglobulin), a calcineurin inhibitor, either mycophenolate mofetil or sirolimus, and rapid discontinuation of prednisone. Actuarial 3-year patient survival was 95%; graft survival, 93%. Acute rejection-free graft survival at 1 year was 94%; at 3 years, 92%. There was no difference between LD and CAD. At 2 years, the mean (± SE) serum creatinine level for LDs was 1.6 ± 0.5 mg/dL; for CAD, 1.6 ± 0.4 mg/dL. We have no new cases of PTLD or avascular necrosis; 22 recipients (6%) developed CMV. Currently, 84% of recipients remain prednisone-free. We conclude that excellent 3-year patient and graft survival can be achieved without maintenance prednisone. With such a protocol, steroid-related side-effects are minimal.

APA Citation

Khwaja, K., Asolati, M., Harmon, J., Melancon, J., Dunn, T., Gillingham, K., Kandaswamy, R., Humar, A., Gruessner, R., Payne, W., Najarian, J., Dunn, D., Sutherland, D., & Matas, A. (2004). Outcome at 3 years with a prednisone-free maintenance regimen: A single-center experience with 349 kidney transplant recipients. American Journal of Transplantation, 4 (6). http://dx.doi.org/10.1111/j.1600-6143.2004.00443.x