Date: Monday, June 13, 2016
Session Time: 4:30pm-6:00pm
Presentation Time: 4:54pm-5:06pm
Location: Ballroom A
Purpose: This study investigated whether steroid avoidance-protocols adversely influence allograft survival among pediatric kidney transplant recipients at high levels of immunologic risk.
Methods: A retrospective cohort analysis of pediatric kidney transplant recipients between 2004 and 2014 in the Organ Procurement and Transplantation Network database was performed. Propensity score analysis was used to compare graft survival in 1580 children who received steroid avoidance with 1580 propensity score-matched children who received steroid-based immunosuppression. Graft survival was evaluated for the entire cohort and among the following immunologic risk strata: repeat kidney transplants, African Americans, highly sensitized (PRA > 80%) children, and recipients of deceased donor and completely HLA-mismatched kidneys. The effect of steroid avoidance on graft failure among immunologic risk strata was estimated using Cox proportional hazards regression with propensity score matching adjustment.
Results: Without propensity score adjustment, 5-year graft survival appeared to be improved among children receiving steroid avoidance (85.4% vs. 79.4%, p < 0.001). In the propensity score-matched cohort, 5-year graft survival was similar in children receiving steroid avoidance and steroid-based protocols (84.7% vs. 82.3%, p = 0.17), confirming the clinical suspicion that steroid avoidance tends to be adopted for patients who have a better prognosis. Within immunologic risk strata, hazard ratios (95% CI) for allograft failure for children receiving steroid avoidance were not significantly different from the null value of 1: repeat kidney transplants, 1.6 (0.78 to 3.3); African Americans, 0.91 (0.65, 1.3); highly sensitized recipients, 1.2 (0.3, 4.8); recipients of deceased donor kidneys, 0.91 (0.73, 1.1); recipients of completely HLA-mismatched kidneys, 0.71 (0.45, 1.1).
Conclusion: Steroid avoidance appears safe with regard to 5-year graft survival in pediatric kidney transplantation, including among transplant recipients at high immunologic risk.
CITATION INFORMATION: Nehus E, Wang Y, Lu B, Liu C, Macaluso M, Kim M.-O. Graft Survival of Steroid-Avoidance Protocols in Pediatric Kidney Transplantation[mdash]A Propensity Score Analysis. Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:Nehus E, Wang Y, Lu B, Liu C, Macaluso M, Kim M-O. Graft Survival of Steroid-Avoidance Protocols in Pediatric Kidney Transplantation[mdash]A Propensity Score Analysis. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/graft-survival-of-steroid-avoidance-protocols-in-pediatric-kidney-transplantationmdasha-propensity-score-analysis/. Accessed April 4, 2020.
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