Impact of Maintenance Steroids versus Rapid Steroid Withdrawal in African-American Kidney Transplant Recipients: Comparison of Two Urban Centers.

W James Chon,Coady Wing,Michelle A Josephson,Amishi Desai,Sanjeev Akkina,Ignatius Y S Tang,Divya Arwindekar

doi:10.4236/ijcm.2016.73021

Abstract

BackgroundRapid steroid withdrawal (RSW) is used increasingly in kidney transplantation but long-term outcomes in African-American (AA) recipients are not well known. We compared 1 and 5 year transplant outcomes in a large cohort of AA patients who were maintained on continued steroid therapy (CST) to those who underwent RSW.MethodsPost-transplant courses of A as receiving kidney allografts from 2003–2011 at two urban transplant centers in Chicago were followed. Prior to outcome analysis, we used Inverse Probability of Treatment Weights (IPTW) to match the two groups on a set of baseline risk factors. Graft and patient survival, GFR at 1 and 5 years, incidence and type of rejection, incidence of post-transplant diabetes mellitus (PTDM), delayed graft function, CMV and BK viremia were compared.ResultsThere were 150 AA recipients in the CST analytic group and 157 in the RSW analytic group. Graft and patient survival was similar between the two groups. Rates of CMV viremia were higher in the RSW compared to the CST analytic group at 1 year. Biopsy-proven acute rejection and PTDM were similar between the RSW and CST groups.ConclusionsIn AA recipients, RSW has similar long-term outcomes to CST.

Highlights

With the availability of more potent immunosuppressive medications, a number of studies have been published over the last two decades evaluating the role of steroid withdrawal in kidney transplantation
The general consensus is that rapid steroid withdrawal (RSW) when compared to continued steroid therapy (CST) is safe and effective and many centers are moving toward a Rapid steroid withdrawal (RSW) protocol [1]-[16]
From 2003 to 2011, 194 patients from the CST group and 212 from the RSW group were initially included in the study

Summary

Introduction

With the availability of more potent immunosuppressive medications, a number of studies have been published over the last two decades evaluating the role of steroid withdrawal in kidney transplantation. In the RSW group, steroids were withdrawn within 5 days post-transplantation To our knowledge this is the only comparison study between RSW and CST in AA recipients. It represents the largest cohort of AAs and the longest outcome data to date in this population. Rapid steroid withdrawal (RSW) is used increasingly in kidney transplantation but long-term outcomes in African-American (AA) recipients are not well known. We compared 1 and 5 year transplant outcomes in a large cohort of AA patients who were maintained on continued steroid therapy (CST) to those who underwent RSW. GFR at 1 and 5 years, incidence and type of rejection, incidence of post-transplant diabetes mellitus (PTDM), delayed graft function, CMV and BK viremia were compared. Conclusions: In AA recipients, RSW has similar long-term outcomes to CST

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Conclusion