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11 Years Experience of Early Steroid Withdrawal Immunosupression Protocol in Kidney Allograft Recipient

O. Adebiyi, A. Sharfuddin, M. Yaqub, D. Mishler, T. Taber, W. Goggins

Indiana University, Indianapolis, IN

Meeting: 2020 American Transplant Congress

Abstract number: B-108

Keywords: Glucocortocoids, Graft survival, Survival

Session Information

Date: Saturday, May 30, 2020

Session Name: Poster Session B: Kidney Immunosuppression: Novel Regimens and Drug Minimization

Session Time: 3:15pm-4:00pm

 Presentation Time: 3:30pm-4:00pm

Location: Virtual

Related Abstracts
  • Simultaneous Pancreas-Kidney Transplant: – The Effects of Early Steroid Withdrawal, Donor and Recipient Variables on Patient Survival
  • Steroid Dependence at 1 Yr in Kidney Transplant Recipients Initiated on Early Steroid Withdrawal Protocol: Associated Risk Factors and Prognosis

*Purpose: Early Steroid Withdrawal (ESW) Immunosuppression protocol has become a viable alternative to steroid based regimen. Our transplant program has adopted ESW protocol since 2003 and hereby present 11 years of our experience.

*Methods: A retrospective chart review of kidney transplant recipients at Indiana University Transplant between 2005 and 2016 was done. Patients with multi-organ transplant follow up time &lt 1 year, or primary kidney transplant failure was excluded from the analysis. All patients received anti-thymocyte globulin as well as pulse steroid induction regimen except for those with 0 antigen mismatch who received basiliximab induction. Patients were weaned off steroid by day 4 and chronically placed on 2 immunosuppression medication regimens.

*Results: 2097 patients were included in the final analysis with a mean follow up time of 6.4 years. Mean age at transplant was 51 years, 60.1% were recipients of deceased donor kidney, 21.8% were African Americans , 15.6% were repeat transplant, 10.3%% had cPRA > 50%, 8% had positive flow cytometry crossmatch, 74.2% were on dialysis before transplant with 45% having been on dialysis for > 3 years. 13.5% were steroid dependent at 1 year. Overall 1 Yr AR was 16.1%. 5 Yr survival probability for DCGS is 96.6% (95% CI: 96-97%) and for 5 yr patient survival is 89.2 %(95% CI: 88-91%). Compared to those without rejection at 1 Yr, those with 1 yr AR had significantly lower probability of DCGS (5 yr: 91% vs. 98) and patient survival (5 yr: 83.5 vs 91.9%, p<0.0001, Figures 1,2). Compared to recipients of living donor kidney, recipients of deceased donor kidney had significantly lower survival probability (5 years: 87.5% vs 91.5%, p<0.0001) but no significant difference in DCGS probability (p=0.1970). Subgroup analysis by ethnicity showed African Americans have significantly higher 1 Yr AR and lower survival probability for 5 Yr DCGS and Patient survival when compared to the Caucasian (p < 0.0001).

*Conclusions: Although, ESW immunosuppression protocol may be associated with slightly increased risk for 1 Yr. AR when compared to published data on steroid based regimen, our data overall shows DCGS and patient survival in the intermediate term highly favors ESW approach.

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To cite this abstract in AMA style:

Adebiyi O, Sharfuddin A, Yaqub M, Mishler D, Taber T, Goggins W. 11 Years Experience of Early Steroid Withdrawal Immunosupression Protocol in Kidney Allograft Recipient [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/11-years-experience-of-early-steroid-withdrawal-immunosupression-protocol-in-kidney-allograft-recipient/. Accessed March 8, 2021.

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