Human Leukocyte Antigen Mismatch and Steroid Maintenace in Kidney Transplantation
Nephrology and Hypertension, Allegheny General Hospital, Pittsburgh, PA.
Meeting: 2015 American Transplant Congress
Abstract number: 206
Keywords: Glucocortocoids, Graft survival, HLA matching
Session Information
Session Name: Concurrent Session: Kidney: Immunosupression Minimization
Session Type: Concurrent Session
Date: Monday, May 4, 2015
Session Time: 2:15pm-3:45pm
Presentation Time: 2:15pm-2:27pm
Location: Room 113-BC
Kidney transplant recipients (KTRs) with zero/minimal HLA mismatches against their donors enjoy superior long term outcomes related to diminished immune response of the recipient against the allograft. These patients may benefit from immunosuppression reduction. Using OPTN/UNOS database,we aimed to analyze the impact of chronic steroid maintenance (CSM) vs. early steroid withdrawal (ESW) in an adjusted model on the outcomes in patients who underwent kidney transplantation from 2001 to 2011 after receiving peri-operative induction therapy with either depleting (rabbit-antithymocyte globulin or alemtuzumab) or non-depleting (basiliximab or daclizumab) antibody followed by calcinuerin inhibitor(CNI)/mycophenolate mofetil (MMF) maintenance and stratified by the level of HLA mismatches. Donor, recipient and transplant variables known to impact outcomes were included in the adjusted model.
Outcomes in zero HLA mismatch and 5-6 HLA mismatches groups are shown in tables 1 and 2 respectively.
| Zero HLA mismatch; n=5324 (CSM = 3416, ESW=1908) | 5-6 HLA mismatches; n=21258 (CSM=13739, ESW=7519) | |||
| H R | 95% CI | H R | 95% CI | |
| Adjusted overall graft failure risk | 1.13* | 0.98-1.28 | 1.04 | 0.98-1.11 |
| Adjusted death-censored graft failure risk | 0.98 | 0.81-1.18 | 0.95 | 0.88-1.03 |
| Adjusted patient death risk | 1.30** | 1.09-1.53 | 1.16*** | 1.06-1.26 |
| Zero HLA mismatch; n=4114 (CSM=3454, ESW=660 | 5-6 HLA mismatches; n=12408 (CSM=10,892; ESW = 1516)) | |||
| HR | 95% CI | HR | 95% CI | |
| Adjusted Overall graft failure risk | 1.30* | 1.04-1.60 | 0.97 | 0.88-1.08 |
| Adjusted death-censored graft failure risk | 1.14 | 0.83-1.58 | 0.94 | 0.81-1.08 |
| Adjusted patient death risk | 1.45** | 1.12-1.90 | 1.02 | 0.88-1.17 |
In summary, regardless of the level of HLA mismatch, ESW appears to be safe in KTRs who receive peri-operative induction therapy and maintenance immunosuppression with CNI/MMF. Moreover, ESW could be advantageous in zero HLA mismatched KTRs since it is associated with a reduction in death with functioning graft in both induction groups. In patients with 5-6 HLA mismatches who received depleting induction, ESW was associated with improved patient survival. Taking all these observations together, it appears that ESW is feasible independent of the levels of HLA mismatches in KTRs who are selected to receive peri-operative induction followed by CNI/MMF maintenance.
To cite this abstract in AMA style:
Sureshkumar K, Marcus R, Chopra B. Human Leukocyte Antigen Mismatch and Steroid Maintenace in Kidney Transplantation [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/human-leukocyte-antigen-mismatch-and-steroid-maintenace-in-kidney-transplantation/. Accessed November 21, 2024.« Back to 2015 American Transplant Congress