Preliminary results with early corticosteroid withdrawal in African American renal allograft recipients

• Published in: Surgery 2005-10, Vol.138 (4), p.772-779
• Main Authors: Gruber, Scott A., West, Miguel S., Sillix, Dale H., El-Amm, Jose M., Garnick, James, Morawski, Katherina, Haririan, Abdolreza
• Format: Article
• Language: English
• Subjects: Acute Disease; Adrenal Cortex Hormones - administration & dosage; Adrenal Cortex Hormones - therapeutic use; Adult; African Americans; Biopsy; Case-Control Studies; Drug Administration Schedule; Graft Rejection - epidemiology; Graft Survival; Humans; Immunosuppressive Agents - therapeutic use; Incidence; Kidney - pathology; Kidney Transplantation - mortality; Leukopenia - epidemiology; Methylprednisolone - administration & dosage; Methylprednisolone - therapeutic use; Middle Aged; Prednisone - administration & dosage; Prednisone - therapeutic use; Retrospective Studies; Survival Analysis; Transplantation, Homologous; Treatment Outcome
• ISSN: 0039-6060; 1532-7361
• DOI: 10.1016/j.surg.2005.06.055

There is a paucity of data regarding the use of steroid-avoidance immunosuppression (SAI) in African American (AA) renal allograft recipients, traditionally considered a high-risk subgroup of patients with higher reported rates of acute rejection and graft loss. We compared the outcomes of 27 AA renal allograft recipients receiving SAI (SA group; mean follow-up period, 12 ± 3 mo) with those of 20 patients receiving a steroid taper (ST group; 24 ± 11 mo). In both groups, thymoglobulin was used for induction, and mycophenolate mofetil and tacrolimus were used for maintenance. Four doses of methylprednisolone were given on days 0 to 3. In the SA group no further steroids were given, whereas in the ST group a prednisone taper was continued thereafter. ST patients were more likely to have current panel reactive antibody titers greater than 10%, undergo retransplantation, and receive more doses of thymoglobulin. There were no significant differences between the SA and ST groups with regard to patient survival (96% vs 95%), graft survival (96% vs 90%), acute rejection (11% vs 14%), cytomegalovirus infection (7% vs 10%), posttransplant diabetes mellitus (11% vs 24%), or mean serum creatinine concentration at 6 months (1.6 vs 1.5 mg/dL), respectively, with a trend toward less percent weight gain in SA patients at 6 months (5% vs 11%, P = .06). SAI can produce excellent short-term results in AA kidney transplant patients when compared with a conventional ST protocol. Our results will need to be verified in larger numbers of patients with longer follow-up evaluation.