Early Steroid Withdrawal in Repeat Kidney Transplantation

Background and objectives Kidney re-transplantation (KRT) candidates are considered at high risk for graft failure. Most of these patients are kept on a chronic steroid maintenance (CSM) regimen. The safety of early steroid withdrawal (ESW) remains unanswered in KRT. Design, setting, participants, & measurements This study was aimed at comparing the outcomes of ESW and CSM in KRT. Retrospective analysis of 113 KRT patients (ESW, n = 59; CSM, n = 54) was performed. All patients received rabbit anti-thymocyte globulin/steroid induction and were maintained on mycophenolate/tacrolimus (+/- steroids). Results One- and 5-year patient survival for the ESW and the CSM group were not significantly different (98 versus 96% and 91 versus 88%, respectively; P = 0.991). No significant difference was seen in the graft survival for both groups at 1 and 5 years (98 versus 93% and 80 versus 74%, respectively; P = 0.779). Mean 1- and 5-year estimated GFR was not statistically different between the groups (P = 0.773 and 0.790, respectively). The incidence of acute rejection at 1 year was 17 and 22% in ESW and CSM patients, respectively (P = 0.635). Compared with the ESW group, patients in the CSM group were more likely to be hyperlipiclemic (P = 0.044), osteoporotic (P = 0.010), post-transplant diabetics (P = 0.051) and required more medications to control BP (P = 0.004). Conclusions ESW seems to be a reasonable approach in KRT recipients because the short and intermediate patient survival, graft survival, and graft function is comparable to CSM immunosuppression. Clin J Am Soc Nephrol 6: 404-411, 2011. doi: 10.2215/CJN.05110610