Steroid withdrawal after kidney transplantation with daclizumab induction

OBJECTIVE: The goal of this study was to demonstrate the non-inferiority of early steroid withdrawal after kidney transplantation. METHODS: A retrospective analysis of 100 transplants was performed. All patients received tacrolimus and mycophenolate mofetil maintenance immunosuppression. The first 51 patients (group S) received antithymocyte globulin (deceased donor) or daclizumab (living donor) for induction and long-term steroids. The next 49 (group NS) received daclizumab and steroids on days 0 and 1 only. RESULTS: There were no statistical differences between the S and NS groups in demographics, delayed graft function, acute cellular rejection (ACR), and 1-year patient and graft survival (96% vs. 98% and 96% vs. 96%). The incidence of ACR in the NS group did not differ between African Americans (7%) and non-African Americans (12%) or between living donors (10%) and deceased donors (11%). We concluded that rapid steroid withdrawal under daclizumab induction provides excellent results. DISCUSSION: This study evaluated a representative US patient population receiving a contemporary immunosuppressive regimen and showed that withdrawal of steroids after 2 doses is a safe and effective strategy as measured by patient and graft survival and incidence of rejection. Longer follow-up will be required to ensure that there are no long-term consequences of steroid avoidance.