Evaluation of an Early Steroid Withdrawal Maintenance Regimen in African American Renal Transplant Recipients.
Brigham and Women's Hospital, Boston, MA.
Meeting: 2016 American Transplant Congress
Abstract number: B120
Keywords: African-American
Session Information
Session Name: Poster Session B: Drug Minimization
Session Type: Poster Session
Date: Sunday, June 12, 2016
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Halls C&D
Introduction: Outcomes in African American (AA) transplant recipients are inferior to other ethnic groups. This population also has an accelerated decline in graft function after renal transplant compared to non-AA populations. Given these facts, there has been reluctance to use an early steroid withdrawal (ESW) maintenance regimen in AA patients, especially given the contradictory data regarding ESW in AA renal transplant recipients (RTR). This analysis evaluated an ESW regimen in both AA and non-AA RTR.
Methods: A retrospective analysis was conducted of adult RTR receiving r-ATG or basiliximab and ESW between January 2004 and December 2014. The patients were divided based on race; non-AA, n=251; AA, n=45. The primary endpoint was a composite of biopsy-proven acute rejection (BPAR), graft loss or death. Secondary endpoints included an analysis of renal function and safety parameters.
Results: Donor and recipient demographics were comparable between groups. All transplant characteristics and immunosuppression, including use of r-ATG induction, tacrolimus levels and mycophenolate doses, were similar throughout the analysis, with the exception of more living donors in the non-AA group (78.5% vs 53.3%; p=0.0007).
| non-AA | AA | p-value | |
| Composite endpoint at 1 year | 15.9% | 15.6% | 1.000 |
| – BPAR | 15.9% | 13.3% | 0.824 |
| – Graft Loss | 0.4% | 2.2% | 0.281 |
| – Death | 0% | 0% | – |
| Secondary endpoints | |||
| – Incidence of delayed graft function | 7.6% | 28.9% | 0.0002 |
| – Serum creatinine (mg/dl) at 1 year | 1.4 + 0.5 | 1.5 + 0.6 | 0.254 |
| – Follow-up (years) | 5.0 + 3.3 | 5.0 + 3.0 | 1.000 |
| – Serum creatinine (mg/dl) at last follow-up | 1.6 + 1.0 | 2.0 + 2.3 | 0.079 |
| – NODAT | 12.7% | 19.4% | 0.400 |
| – Opportunistic infections | 13.1% | 24.4% | 0.067 |
| – Malignancy (de novo; any type) | 3.2% | 4.4% | 0.652 |
There were no differences seen in myelosuppression or cardiovascular (lipids, blood pressure) outcomes between the groups throughout the evaluation period.
Conclusions: There were no differences seen in rejection, graft loss, or patient death between AA and non-AA receiving a maintenance ESW regimen. There was a trend towards worsening renal function and higher rates of opportunistic infection on last follow-up, but neither reached statistical significance.
CITATION INFORMATION: Gabardi S, Kim M, Alsheikh R, Townsend K, Chandraker A. Evaluation of an Early Steroid Withdrawal Maintenance Regimen in African American Renal Transplant Recipients. Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:
Gabardi S, Kim M, Alsheikh R, Townsend K, Chandraker A. Evaluation of an Early Steroid Withdrawal Maintenance Regimen in African American Renal Transplant Recipients. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/evaluation-of-an-early-steroid-withdrawal-maintenance-regimen-in-african-american-renal-transplant-recipients/. Accessed November 22, 2024.« Back to 2016 American Transplant Congress