Intermediate-term outcomes with early steroid withdrawal in African-American renal transplant recipients undergoing surveillance biopsy

• Published in: Surgery Vol. 142; no. 4; pp. 538 - 545
• Main Authors: Zeng, Xu, MD, PhD, El-Amm, Jose M., MD, Doshi, Mona D., MD, Singh, Atul, MD, Morawski, Katherina, RN, BSN, CNN, Cincotta, Elizabeth, PharmD, Losanoff, Julian E., MD, West, Miguel S., MD, Gruber, Scott A., MD, PhD, MBA
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 01.10.2007
• Subjects: Acute Disease; Adrenal Cortex Hormones - administration & dosage; Adult; African Americans - statistics & numerical data; Biopsy - statistics & numerical data; Follow-Up Studies; Graft Rejection - drug therapy; Graft Rejection - ethnology; Graft Survival; Humans; Immunosuppression; Incidence; Kidney Transplantation - ethnology; Kidney Transplantation - statistics & numerical data; Middle Aged; Retrospective Studies; Risk Factors; Surgery; Transplantation, Homologous; Treatment Outcome
• ISSN: 0039-6060; 1532-7361
• DOI: 10.1016/j.surg.2007.07.006

Background There is a paucity of data regarding the use of early corticosteroid withdrawal (ESW) in African-American renal allograft recipients, and very few reports with ≥1 year follow-up in all patients. Methods We examined the outcomes of 57 African-American renal allograft recipients with minimum follow-up 12 months who did not receive maintenance steroids after day 4 posttransplant. All patients received thymoglobulin induction, mycophenolate mofetil, and initial tacrolimus (n = 48) or sirolimus (n = 9). Results Patient and graft survival were 98% and 96% at 1 year, and 95% and 89% over the entire follow-up period (mean, 23 ± 8 months). Incidence of acute rejection and cytomegalovirus infection were 18% and 7%, respectively, with mean serum creatinine 1.6 ± 0.5 and 1.7 ± 0.9 mg/dL at 6 and 12 months. Of patients with functioning grafts, 84% remained steroid free at 1 year, of which 11 (24%) were also calcineurin inhibitor free. Twenty-seven patients underwent surveillance biopsy at 1 month and 28 at 12 months, with 15 surveyed at both time points. There were significant increases in only 2 of the 6 1997 Banff chronic allograft nephropathy (CAN) category scores in this subgroup, with all mean values remaining <1 (mild in severity) at 1 year. Overall, from 82% to 96% of the 12-month scores were ≤1 in all categories for 28 patients; only 3 patients (11%) had interstitial fibrosis and tubular atrophy scores at least moderate in severity. We did not observe any cases of subclinical acute rejection. Conclusions Our findings suggest that ESW in African-American renal allograft recipients with multiple high-risk factors can produce excellent intermediate-term antirejection and graft functional outcomes with minimal development of CAN at 12 months. Our results will need to be verified in larger numbers of patients with longer follow-up.