Stopping Steroids In Low Risk Kidney Transplant Patients

A 15-year follow-up of a randomized trial showed that low-to moderate-risk kidney transplant patients treated with corticosteroids as part of immunosuppressive regimen did not show significant reductions in the risk of allograft failure or patient death compared with those not receiving corticosteroids. The research is published in the JAMA Surgery.

The authors concluded, “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.”

These findings add to important evidence of acceptable outcomes when low-risk transplant patients withdraw from corticosteroids. Arthur J. Matas of the Division of Transplantation, Department of Surgery, University of Minnesota, Minneapolis has said that the study provided a long-term data showing that recipients of kidney transplants are not at a disadvantage if steroids are stopped early.

He added, “Going forward, in contrast with justifying early steroid cessation, transplant centers using steroids should justify why they are using steroids for their recipients or recipient subpopulations, given that there is no evidence of improved outcomes and steroids have adverse effects.”

The results have been derived from a long-term follow-up of a 2008 study, which is the most rigorous randomized trial of corticosteroid withdrawal in kidney transplant patients to date. For the study, 386 adult kidney transplant recipients with low to moderate immune risk were enrolled. These patients received kidney form deceased or living donor at 28 kidney transplant centers in the United States.

The transplant recipients were randomized to withdrawal from corticosteroids 7 days after transplant (191 patients) or to continue maintenance with corticosteroids (195 patients) at a dose of 5 mg/day. Additionally, all the patients received initial immunosuppresion with a T-cell–depleting or T-cell–non-depleting antibody and maintenance tacrolimus and mycophenolate mofetil.

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In the original trial which had a follow-up of 5 years, did not show any differences between groups in the composite primary endpoint of death, allograft loss censored for patient death, or moderate to severe short-term rejection. However, it did show a higher rate of biopsy-confirmed rejection among patients withdrawn from corticosteroids as compared to those patients who continued them.

Even though, kidney function was similar between the two groups, patients withdrawn from corticosteroids had lower rates of some of the side effects associated with steroid use like weight gain, serum triglyceride levels, and insulin-requiring diabetes.

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Source-Medindia