Ten-year outcome after rapid discontinuation of prednisone in adult primary kidney transplantation. Clin J Am Soc Nephrol 2012 Mar;7(3):494-503
Date
01/28/2012Pubmed ID
22282482Pubmed Central ID
PMC3302679DOI
10.2215/CJN.08630811Scopus ID
2-s2.0-84858028820 (requires institutional sign-in at Scopus site) 62 CitationsAbstract
BACKGROUND AND OBJECTIVES: Rapid discontinuation of prednisone after kidney transplantation potentially allows for minimization of steroid-related side effects. Although intermediate-term data with rapid discontinuation of prednisone have been promising, concern still exists regarding long-term outcomes. The 10-year experience is reported herein.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Between October 1, 1999 and December 31, 2010, 1241 adult primary kidney transplants (791 living donor and 450 deceased donor) were performed using a protocol in which prednisone is discontinued after postoperative day 5. The 10-year actuarial recipient and graft survival rates and prednisone-related side effects were studied.
RESULTS: Ten-year actuarial patient survival was 71% for living donor transplants and 62% for deceased donor transplants; 10-year graft survival was 61% for living donor transplants and 51% for deceased donor transplants, and was comparable to 10-year Scientific Registry of Transplant Recipients national data. Ten-year death-censored graft survival was 79% for living donor transplants and 80% for deceased donor transplants. Ten-year acute rejection rates were 25% for deceased donor transplants and 31% for living donor transplants; 10-year chronic rejection (interstitial fibrosis/tubular atrophy) rates were 39% for deceased donor transplants and 47% for living donor transplants. For nondiabetic recipients of living donor or deceased donor allografts, the incidence of new-onset diabetes was significantly lower than in historical controls on prednisone (P<0.001). We also found significantly reduced rates of cataracts, avascular necrosis, and cytomegalovirus infection in some subgroups.
CONCLUSIONS: Prednisone-related side effects can be minimized in a protocol incorporating rapid discontinuation of prednisone for maintenance immunosuppression. Ten-year patient and graft outcomes remain acceptable.
Author List
Rizzari MD, Suszynski TM, Gillingham KJ, Dunn TB, Ibrahim HN, Payne WD, Chinnakotla S, Finger EB, Sutherland DE, Kandaswamy R, Najarian JS, Pruett TL, Kukla A, Spong R, Matas AJAuthor
Ty Blink Dunn MD Professor in the Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdultDrug Administration Schedule
Female
Graft Rejection
Graft Survival
Humans
Immunosuppressive Agents
Kaplan-Meier Estimate
Kidney Transplantation
Living Donors
Male
Middle Aged
Minnesota
Prednisone
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome