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Early Steroid Withdrawal Does Not Worsen Long-Term Kidney Graft Survival (SPH Dr. John Gill)

Corticosteroids may not be necessary as part of a calcineurin-based multiple drug immunosuppressive regimen in kidney transplant recipients, according to investigators. (Photo credit: Renal and Urology News)
Corticosteroids may not be necessary as part of a calcineurin-based multiple drug immunosuppressive regimen in kidney transplant recipients, according to investigators. (Photo credit: Renal and Urology News)

Cessation of corticosteroids does not confer excess risk for allograft failure over the long term, according to new data. 

In a trial of 385 recipients (mean age 46.5 years) of a living or deceased donor kidney transplant who were at low-to-moderate immune risk (peak panel reactive antibody less than 50% and pretransplant panel reactive antibody less than 25%), investigators randomly assigned 191 patients to withdraw from corticosteroids within 7 days and 194 patients to continue corticosteroids at a dose of 5 mg per day, in addition to taking tacrolimus and mycophenolate mofetil. The study excluded patients who had short-term delayed graft function or rejection in the first week after transplantation (defined by a minimum 30% reduction in pretransplant serum creatinine level within 7 days).

In 2008, the investigators reported no significant differences between groups in 5-year graft loss (composite outcome). In the current study, the investigators provided longer-term follow up data using the Organ Procurement and Transplant Network registry. Over a median 15.8 years, allograft failure from any cause or censored for patient death did not differ significantly between the groups who continued or discontinued corticosteroids, John S. Gill, MD, MS, of St Paul’s Hospital in Vancouver, BC, Canada, and colleagues reported in JAMA Surgery.

“Long-term corticosteroids may not be necessary as part of a calcineurin-based multiple drug immunosuppressive regimen in low-to-moderate immune risk kidney transplant recipients,” Dr Gill’s team concluded.

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