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Early corticosteroid withdrawal regimen in a living donor kidney transplantation program

Steroids have been the essential component of transplant immunosuppression. Recently, with availability of better immunosuppressive agents, many centers have started steroid free transplant with good success rates. We analyzed the outcomes of early corticosteroid withdrawal (CSW) protocol in our liv...

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Autores principales: Bansal, S. B., Sethi, S., Sharma, R., Jain, M., Jha, P., Ahlawat, R., Duggal, R., Kher, V.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4119336/
https://www.ncbi.nlm.nih.gov/pubmed/25097336
http://dx.doi.org/10.4103/0971-4065.133004
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author Bansal, S. B.
Sethi, S.
Sharma, R.
Jain, M.
Jha, P.
Ahlawat, R.
Duggal, R.
Kher, V.
author_facet Bansal, S. B.
Sethi, S.
Sharma, R.
Jain, M.
Jha, P.
Ahlawat, R.
Duggal, R.
Kher, V.
author_sort Bansal, S. B.
collection PubMed
description Steroids have been the essential component of transplant immunosuppression. Recently, with availability of better immunosuppressive agents, many centers have started steroid free transplant with good success rates. We analyzed the outcomes of early corticosteroid withdrawal (CSW) protocol in our living donor kidney transplant programme. We included 73 patients on CSW protocol on basiliximab + tacrolimus and mycophenolate mofetil and compared them with 67 recipients on similar regimen with corticosteroids (CSs). CSW group received prednisolone 40 mg on day 1, which was stopped on day 5. Outcomes were evaluated in terms of acute rejection (AR), infections, new onset diabetes after transplant (NODAT), renal function and graft or patient loss. In CSW group, 15/73 (20.5%) patients developed AR, when compared to 5/67 (7.5%) in CS group, (P = 0.02). Biopsy proven acute rejection was seen in 12/72 (16.6%) in CSW group and 5/67 (7.5%) in CS (P = 0.1). One patient in CSW group developed antibody mediated rejection. NODAT was similar (9% in CS vs. 3.7% in CSW, P = 0.09), but infections were higher in CSW group (20.5% vs. 7.5%, P = 0.02). Mean serum creatinine was similar at 6 months (1.24 ± 0.6 in CS and 1.25 ± 0.3 in CSW, P = 0.9). Graft survival was 100% and 97% (P = 0.1) and patient survival was 98.6% and 98.5% (P = 0.9) in CSW and CS groups. Early corticosteroid withdrawal with basiliximab induction was associated with increased risk of AR but did not have any effect on short term graft and pateint survival.
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spelling pubmed-41193362014-08-05 Early corticosteroid withdrawal regimen in a living donor kidney transplantation program Bansal, S. B. Sethi, S. Sharma, R. Jain, M. Jha, P. Ahlawat, R. Duggal, R. Kher, V. Indian J Nephrol Original Article Steroids have been the essential component of transplant immunosuppression. Recently, with availability of better immunosuppressive agents, many centers have started steroid free transplant with good success rates. We analyzed the outcomes of early corticosteroid withdrawal (CSW) protocol in our living donor kidney transplant programme. We included 73 patients on CSW protocol on basiliximab + tacrolimus and mycophenolate mofetil and compared them with 67 recipients on similar regimen with corticosteroids (CSs). CSW group received prednisolone 40 mg on day 1, which was stopped on day 5. Outcomes were evaluated in terms of acute rejection (AR), infections, new onset diabetes after transplant (NODAT), renal function and graft or patient loss. In CSW group, 15/73 (20.5%) patients developed AR, when compared to 5/67 (7.5%) in CS group, (P = 0.02). Biopsy proven acute rejection was seen in 12/72 (16.6%) in CSW group and 5/67 (7.5%) in CS (P = 0.1). One patient in CSW group developed antibody mediated rejection. NODAT was similar (9% in CS vs. 3.7% in CSW, P = 0.09), but infections were higher in CSW group (20.5% vs. 7.5%, P = 0.02). Mean serum creatinine was similar at 6 months (1.24 ± 0.6 in CS and 1.25 ± 0.3 in CSW, P = 0.9). Graft survival was 100% and 97% (P = 0.1) and patient survival was 98.6% and 98.5% (P = 0.9) in CSW and CS groups. Early corticosteroid withdrawal with basiliximab induction was associated with increased risk of AR but did not have any effect on short term graft and pateint survival. Medknow Publications & Media Pvt Ltd 2014 /pmc/articles/PMC4119336/ /pubmed/25097336 http://dx.doi.org/10.4103/0971-4065.133004 Text en Copyright: © Indian Journal of Nephrology http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Bansal, S. B.
Sethi, S.
Sharma, R.
Jain, M.
Jha, P.
Ahlawat, R.
Duggal, R.
Kher, V.
Early corticosteroid withdrawal regimen in a living donor kidney transplantation program
title Early corticosteroid withdrawal regimen in a living donor kidney transplantation program
title_full Early corticosteroid withdrawal regimen in a living donor kidney transplantation program
title_fullStr Early corticosteroid withdrawal regimen in a living donor kidney transplantation program
title_full_unstemmed Early corticosteroid withdrawal regimen in a living donor kidney transplantation program
title_short Early corticosteroid withdrawal regimen in a living donor kidney transplantation program
title_sort early corticosteroid withdrawal regimen in a living donor kidney transplantation program
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4119336/
https://www.ncbi.nlm.nih.gov/pubmed/25097336
http://dx.doi.org/10.4103/0971-4065.133004
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