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Outcome at 3 years with a prednisone-free maintenance regimen: a single-center experience with 349 kidney transplant recipients.
- Source :
-
American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons [Am J Transplant] 2004 Jun; Vol. 4 (6), pp. 980-7. - Publication Year :
- 2004
-
Abstract
- 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.
- Subjects :
- Antilymphocyte Serum therapeutic use
Case-Control Studies
Creatinine blood
Female
Humans
Immunosuppression Therapy
Male
Middle Aged
Mycophenolic Acid therapeutic use
Necrosis
Sirolimus therapeutic use
Time Factors
Graft Rejection drug therapy
Graft Survival
Immunosuppressive Agents therapeutic use
Kidney Transplantation mortality
Mycophenolic Acid analogs & derivatives
Prednisone administration & dosage
Subjects
Details
- Language :
- English
- ISSN :
- 1600-6135
- Volume :
- 4
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons
- Publication Type :
- Academic Journal
- Accession number :
- 15147433
- Full Text :
- https://doi.org/10.1111/j.1600-6143.2004.00443.x