Clinicopathological Evaluation of Long-Term Survivor More Than 10 Years after Living Kidney Transplant with Corticosteroid Early Withdrawal Protocol
1Kidney Transplant Surgery, Sapporo City General Hospital, Sapporo, Japan, 2Pharmacy, Sapporo City General Hospital, Sapporo, Japan
Meeting: 2020 American Transplant Congress
Abstract number: A-003
Keywords: Induction therapy, Kidney transplantation, Nephrotoxicity, Osteoporosis
Session Information
Session Name: Poster Session A: Kidney Immunosuppression: Induction Therapy
Session Type: Poster Session
Date: Saturday, May 30, 2020
Session Time: 3:15pm-4:00pm
Presentation Time: 3:30pm-4:00pm
Location: Virtual
*Purpose: We have previously reported that favorable short-term outcomes of kidney recipients were achieved by corticosteroid early withdrawal protocol (CSEW) compared to the conventional protocol with chronic steroid treatment, but it has not been unclear clinical and pathological effect on graft/ recipients for a long time.
*Methods: Enrolled patients were 91 who underwent ABO compatible kidney transplant (KT) from living-related donors in our hospital. Among 91, 48 recipients were treated with CSEW consisted of tacrolimus (TAC), mycophenolate mofetil (MMF) and only 3 doses of perioperative methylprednisolone (CSEW group). Historical control group was composed of 43 recipients who received chronic steroid in addition to TAC/MMF (Control group). Basiliximab was also used as induction mAb in each group. Graft and patient survival, the incidence of acute and chronic rejection, pathological results of biopsy specimen and adverse effects were analyzed retrospectively.
*Results: There were no statistical differences in age at transplant, sex, donor age, HLA- mismatch and duration of renal replacement therapy between the two groups, but observed period was significantly longer in control group. (14y vs 10y, p<0.001) Patient survival and graft survival were comparable at 10 years after KT between CSEW and control group. (97% vs 89% p=0.09, 91% vs 85% p=0.74, respectively) (Fig. 1 and 2) Incidence of acute and chronic rejection was also similar. In pathological study, however, Banff aah-score indicating calcineurin inhibitor toxicity (CNIT) was markedly increased in CSEW at 5 year after KT compared to control group (0.97 vs 0.22, p=0.04) (Fig. 3) despite of no difference in TAC-AUC (Area Under the Curve), suggesting that chronic steroid may reduce CNIT. On the other hand, the incidence of de novo DM, infection and cancer was equivalent while treatment of osteopenia was suppressed in CSEW. (27% vs 10%, p=0.037) (Table 1)
*Conclusions: CSEW has achieved promising graft outcome even with CNIT in long-term, with preventing bone-related steroid complication.
To cite this abstract in AMA style:
Sasaki H, Tanabe T, Higuchi H, Tsujimoto T, Harada H. Clinicopathological Evaluation of Long-Term Survivor More Than 10 Years after Living Kidney Transplant with Corticosteroid Early Withdrawal Protocol [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/clinicopathological-evaluation-of-long-term-survivor-more-than-10-years-after-living-kidney-transplant-with-corticosteroid-early-withdrawal-protocol/. Accessed May 11, 2025.« Back to 2020 American Transplant Congress