Ten-Year Outcome after Rapid Discontinuation of Prednisone in Adult Primary Kidn

[Clark]

http://cjasn.asnjournals.org/content/early/2012/01/25/CJN.08630811.abstract

Ten-Year Outcome after Rapid Discontinuation of Prednisone in Adult Primary Kidney Transplantation
Michael D. Rizzari*,†, Thomas M. Suszynski*, Kristen J. Gillingham*, Ty B. Dunn*, Hassan N. Ibrahim‡, William D. Payne*, Srinath Chinnakotla*, Erik B. Finger*, David E. R. Sutherland*, Raja Kandaswamy*, John S. Najarian*, Timothy L. Pruett*, Aleksandra Kukla‡, Richard Spong‡, Arthur J. Matas*

Abstract

Background and objectives Rapid discontinuation of prednisone after kidney transplantation potentially allows for minimization of steroid-related side effects. Although intermediate-term data with rapid discontinuation of prednisone have been promising, concern still exists regarding long-term outcomes. The 10-year experience is reported herein.

Design, setting, participants, & measurements Between October 1, 1999 and December 31, 2010, 1241 adult primary kidney transplants (791 living donor and 450 deceased donor) were performed using a protocol in which prednisone is discontinued after postoperative day 5. The 10-year actuarial recipient and graft survival rates and prednisone-related side effects were studied.

Results Ten-year actuarial patient survival was 71% for living donor transplants and 62% for deceased donor transplants; 10-year graft survival was 61% for living donor transplants and 51% for deceased donor transplants, and was comparable to 10-year Scientific Registry of Transplant Recipients national data. Ten-year death-censored graft survival was 79% for living donor transplants and 80% for deceased donor transplants. Ten-year acute rejection rates were 25% for deceased donor transplants and 31% for living donor transplants; 10-year chronic rejection (interstitial fibrosis/tubular atrophy) rates were 39% for deceased donor transplants and 47% for living donor transplants. For nondiabetic recipients of living donor or deceased donor allografts, the incidence of new-onset diabetes was significantly lower than in historical controls on prednisone (P<0.001). We also found significantly reduced rates of cataracts, avascular necrosis, and cytomegalovirus infection in some subgroups.

Conclusions Prednisone-related side effects can be minimized in a protocol incorporating rapid discontinuation of prednisone for maintenance immunosuppression. Ten-year patient and graft outcomes remain acceptable.