Impact of Steroid Maintenance on the Outcomes of HLA-DR Mismatch Kidney Transplantation
Allegheny General Hospital, Pittsburgh, PA.
Meeting: 2018 American Transplant Congress
Abstract number: C88
Keywords: HLA-DR antigens, Immunosuppression, Kidney transplantation
Session Information
Session Name: Poster Session C: Kidney Immunosuppression: Novel Regimens and Drug Minimization
Session Type: Poster Session
Date: Monday, June 4, 2018
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall 4EF
In kidney transplantation, donor-recipient HLA-DR mismatch poses high immunologic risk and is associated with inferior outcomes. We aimed to explore the impact of enhanced immunosuppression with chronic steroid maintenance (CSM) on the long-term outcomes in kidney transplant recipients (KTx) with varying levels of donor-recipient HLA-DR mismatches. Using the OPTN/UNOS data base, we identified adult kidney only transplant recipients from 2001-2015, who received induction therapy and were discharged on calcineurine inhibitor/mycophenolic acid (CNI/MMF) based maintenance immunosuppression with or without steroids. Patients were then stratified by the number of donor-recipient HLA-DR mismatches (0,1,2) in both living donor kidney (LDKR) and deceased donor kidney (DDKR) transplant recipients. Using a Cox model adjusting for donor, transplant and recipient factors, overall and death-censored graft failure risks along with patient death risk were compared for CSM vs. early steroid withdrawal under each HLA-DR mismatch category in LDKR and DDKR groups. Results are shown in Table 1.
| Living Donor Transplant | Deceased Donor Transplant | |||||
| Number of HLA-DR mismatches | 0 | 1 | 2 | 0 | 1 | 2 |
| Chonic steroid maintenance (n) | 4,451 | 12,474 | 6,809 | 10,020 | 20,134 | 17,046 |
| Early steroid Withdrawal (n) | 2,494 | 7,103 | 3,916 | 3,895 | 7,860 | 5,967 |
| Adjusted overall graft failure risk (HR with 95%CI) | 1.19 (1.04-1.37) * | 1.07 (0.99-1.15) | 1.03 (0.93-1.14) | 1.09 (1.01-1.19)* | 1.06 (1.00-1.12)* | 1.02 (p.96-1.08) |
| Adjusted death censored graft failure risk (HR with 95%CI) | 1.05 (0.86- 1.27) | 0.95 (0.86- 1.05 ) | 0.91 (0.80-1.03) | 0.94 (0.83-1.05) | 1.02 (0.95- 1.10) | 0.92 (0.85-0.99)* |
| Adjusted patient death risk (HR with 95%CI) | 1.26 (1.06-1.50)* | 1.19 (1.08-1.30)*** | 1.12 (0.98-1.28) | 1.22 (1.10- 1.35)*** | 1.11 (1.04-1.18)** | 1.15 (1.07- 1.23)*** |
| p value: *= <0.05, **= <0.005, ***= <0.0001 | ||||||
Our study did not show benefit of CSM in KTx at different levels of donor-recipient HLA-DR mismatches who received induction and were discharged on CNI/MMF maintenance. Adverse patient outcomes associated with CSM in LDKR with 0-1 HLA-DR mismatches and DDKR with all levels of mismatches could reflect consequences of enhanced immunosuppression. Retrospective study design and possibility of residual confounding are study limitations.
CITATION INFORMATION: Chopra B., Sureshkumar K. Impact of Steroid Maintenance on the Outcomes of HLA-DR Mismatch Kidney Transplantation Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Chopra B, Sureshkumar K. Impact of Steroid Maintenance on the Outcomes of HLA-DR Mismatch Kidney Transplantation [abstract]. https://atcmeetingabstracts.com/abstract/impact-of-steroid-maintenance-on-the-outcomes-of-hla-dr-mismatch-kidney-transplantation/. Accessed November 21, 2024.« Back to 2018 American Transplant Congress