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Outcome at 3 Years with a Prednisone‐Free Maintenance Regimen: A Single‐Center Experience with 349 Kidney Transplant Recipients
Author(s) -
Khwaja Khalid,
Asolati Massimo,
Harmon James,
Melancon J. Keith,
Dunn Ty,
Gillingham Kristen,
Kandaswamy Raja,
Humar Abhinav,
Gruessner Rainer,
Payne William,
Najarian John,
Dunn David,
Sutherland David,
Matas Arthur J.
Publication year - 2004
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/j.1600-6143.2004.00443.x
Subject(s) - medicine , prednisone , thymoglobulin , regimen , discontinuation , single center , calcineurin , surgery , urology , kidney transplantation , gastroenterology , basiliximab , transplantation
Historically, late steroid withdrawal after kidney transplants has been associated with an increased rejection rate. Recently, low rejection rates have been reported for recipients treated with complete avoidance or rapid elimination of steroids. However, follow‐up has been short. We herein report on 3‐year outcome in recipients whose prednisone was rapidly eliminated and who were maintained on a steroid‐free regimen. From 10/1/1999 through 5/1/2003, 349 recipients (254 LD, 95 CAD; 319 in first 30 s) were immunosuppressed with polyclonal antibody (Thymoglobulin), a calcineurin inhibitor, either mycophenolate mofetil or sirolimus, and rapid discontinuation of prednisone.Actuarial 3‐year patient survival was 95%; graft survival, 93%. Acute rejection‐free graft survival at 1 year was 94%; at 3 years, 92%. There was no difference between LD and CAD. At 2 years, the mean (± SE) serum creatinine level for LDs was 1.6 ± 0.5 mg/dL; for CAD, 1.6 ± 0.4 mg/dL. We have no new cases of PTLD or avascular necrosis; 22 recipients (6%) developed CMV. Currently, 84% of recipients remain prednisone‐free. We conclude that excellent 3‐year patient and graft survival can be achieved without maintenance prednisone. With such a protocol, steroid‐related side‐effects are minimal.