Intermediate-term outcomes with early steroid withdrawal in African-American renal transplant recipients undergoing surveillance biopsy

Background. There is a paucity of data regarding the use of early corticosteroid withdrawal (ESW) in 19 African American renal allograft recipients, and very few reports with ? 1 year follow-up in all patients. Methods. We examined the outcomes of 57 African American renal allograft recipients with minimum follow-up 12 months who did not receive maintenance steroids after day 4 posttransplant. All patients received thymoglobulin induction, mycophenolate mofetil, and initial tacrolimus (n = 48) or sirolimus (n = 9). Results. Patient and graft survival were 98% and 96% at 1 year, and 95% and 89% over the entire follow-up period (mean, 23 8 months). Incidence of acute rejection, and cytomegalovirus infection were 18% and 7%, respectively, with mean serum creatinine 1.6 +/- 0.5 and 1.7 +/- 0.9 mg/dL at 6 and 12 months. Of patients with functioning grafts, 84% remained steroid free at 1 year, of which 11 (24%) were also calcineurin inhibitor free. Twenty-seven patients underwent surveillance biopsy at 1 month and 28 at 12 months, with 15 surveyed at both time points. There were significant increases in only 2 of the 6 1997 Banff chronic allograft nephropathy (CAN) category scores in this subgroup, with all mean values remaining < 1 (mild in severity) at 1 year. Overall, from 82% to 96% of the 12-month scores were <= 1 in all categories for 28 patients; only 3 patients (11%) had interstitial fibrosis and tubular atrophy scores at least moderate in severity. We did not observe any cases of subclinical acute rejection. Conclusions. Our findings suggest that ESW in African-American renal allograft recipients with multiple high-risk factors can produce excellent intermediate-term antirejection and graft functional outcomes with minimal development of CAN at 12 months. Our results will need to be verified in larger numbers of patients with longer follow-up.