Steroid-Sparing Renal Transplant Yields Successful Outcomes
(HealthDay News) – Rapid discontinuation of prednisone (RDP) five days after renal transplantation from a living (LD) or deceased donor (DD) yields acceptable 10-year patient and graft outcomes, according to research published online Jan. 26 in the Clinical Journal of the American Society of Nephrology.
Michael D. Rizzari, MD, of the University of Minnesota in Minneapolis, and colleagues provided 10-year actuarial recipient and graft survival rates from 1,241 adult primary kidney transplant recipients; 791 received a kidney from a LD and 450 from a deceased donor DD. All procedures involved RDP after postoperative Day Five.
The researchers found that, for LD kidney recipients, the 10-year actuarial patient survival rate was 71%, compared to 62% for DD recipients. Ten-year graft-survival rates were 61% and 51% for LD and DD recipients, respectively, while death-censored graft survival rates were 79% and 80% for LD and DD, respectively. Acute rejection rates were 31% and 25%, respectively, and chronic rejection due to interstitial fibrosis/tubular atrophy occurred in 47% and 39% of LD and DD recipients, respectively. For patients who underwent RDP after renal transplantation, the incidence of new-onset diabetes was significantly lower than that reported for historical controls taking prednisone. Similarly, rates of cataracts, avascular necrosis, and cytomegalovirus infection were lower than historical control rates for some patient subgroups.
"Because prednisone use is associated with numerous side effects, transplant recipients say it is the drug they would most like to avoid. Our data suggest that long-term prednisone may not be necessary after a kidney transplant," a coauthor said in a statement. "About 30% of new kidney transplants in the United States are now done with a protocol similar to ours."