Early steroid avoidance (SA) in renal transplantation has been associated with more acute rejections compared to steroid continuation (SC) protocols. After graft failure, the long term effect of SA on immune modulation in relisted patients is unknown. We hypothesize that in failed renal transplant recipients, SA reduces the chance of retransplantation (ReTx) compared to SC protocols.
Methods: In the SRTR database, we examined solitary 1st renal transplant adult recipients transplanted between 1994-2008 with graft failure and were subsequently relisted for a solitary 2nd renal transplant between 1999-2008. Patient stratification into SA or SC was determined by whether steroids were stopped or continued at the time of hospital discharge from their 1st renal transplant surgery. The primary outcome was 5-year deceased donor ReTx rate. Zero-mismatched 2nd transplant recipients were excluded. A multivariate competing risk Cox model identified risk factors for ReTx.
Results: We found 5032 patients with 1st renal graft failure and subsequent listing for ReTx. SA was used in 580 patients (12%). Compared to SC, the 5-year mortality rate on the waiting list was higher with SA (28% v 15%, p<.0001) and the 5-year death censored ReTx rate was lower with SA (69% v 82%, p<.0001). After adjusting for risk factors including immunotherapy, OPO waitlist time, transplant year and relisting year; the multivariate model showed that SA was strongly associated with a reduced chance of ReTx (AOR=0.75, 95% CI [0.61-0.92]). Other risk factors for reduced ReTx include sensitization prior to 1st graft, black race, HLA mismatch ≥2, and induction other than ATG/alemtuzumab/IL-2 receptor blocker (Fig.1). Interestingly, no difference in biopsy proven acute rejection was seen between SA and SC (14% v 15%, p=0.43).
Conclusion: In patients with failed renal transplants, we saw significantly fewer ReTx with SA compared to SC. This unexpected finding serves as a caution when considering SA protocols and highlights the importance of further investigation of the long term effects of SA.
To cite this abstract in AMA style:Casey M, Wen X, Santos A, Rehman S, Meier-Kriesche H, Schold J. Early Steroid Avoidance Reduces the Chance for a Subsequent Transplant in Renal Transplant Recipients with Graft Failure [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/early-steroid-avoidance-reduces-the-chance-for-a-subsequent-transplant-in-renal-transplant-recipients-with-graft-failure/. Accessed October 24, 2020.
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