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Prednisone‐Free Maintenance Immunosuppression—A 5‐Year Experience
Author(s) -
Matas Arthur J.,
Kandaswamy Raja,
Gillingham Kristen J.,
McHugh Lois,
Ibrahim Hassan,
Kasiske Bertram,
Humar Abhinav
Publication year - 2005
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.1600-6143.2005.01051.x
Subject(s) - prednisone , medicine , immunosuppression , maintenance therapy , surgery , discontinuation , kidney transplantation , transplantation , chemotherapy
Concern persists that prednisone‐free maintenance immunosuppression in kidney transplant recipients will be associated with an increase in late allograft dysfunction and graft loss. We herein report 5‐year follow‐up of a trial of prednisone‐free maintenance immunosuppression. From October 1, 1999, through January 31, 2005, at our center, 589 kidney transplant recipients were treated with a protocol incorporating discontinuation of their prednisone on postoperative day 6. At 5 years, actuarial patient survival was 91%; graft survival, 84%; death‐censored graft survival, 92%; acute rejection‐free graft survival, 84% and chronic rejection‐free graft survival, 87%. The mean serum creatinine level (±SD) at 1 year was 1.6 ± 0.6; at 5 years, 1.7 ± 0.8. In all, 86% of kidney recipients with functioning grafts remain prednisone‐free as of April 30, 2005.As compared with historical controls, recipients on prednisone‐free maintenance immunosuppression had a significantly lower rate of a number of complications, including cataracts (p < 0.001), posttransplant diabetes mellitus (p < 0.001), avascular necrosis (p = 0.001), and fractures (p = 0.004). We conclude that prednisone‐related side effects can be minimized in a protocol incorporating prednisone‐free maintenance immunosuppression. Five‐year graft outcome remains good.