Objective: Successful RDP (rapid discontinuation of prednisone <1 week post-tx) after kidney transplant (KTx) has been reported for low-risk populations. We studied the impact of RDP in KTx subpopulations thought to be at increased risk.

Methods: Using SRTR data, we studied patient survival (PS) and death-censored graft survival (DCGS) in 1st and 2^nd KTx-alone recipients between 1/1/2000-12/31/2014 with follow-up through 6/30/2016. We defined RDP based on the maintenance immunosuppression (MIS) at discharge. We restricted analysis to those with typical induction (IL2 inhibitors, thymoglobulin, or none) and maintenance IS (TAC + MMF or CSA + MMF) during the study. To assess the effect of RDP, we fit mixed-effect Cox proportional hazards models adjusting for IS regimen, recipient (age, race, gender, BMI, functional status, pre-tx dialysis, primary disease, diabetes [y/n], peak PRA), donor (age, race, HTN [y/n], creatinine, cause of death, DBD vs DCD, HLA mm), and surgical (ischemic time, date tx) characteristics. Transplant center was included as a random effect. Separate models were fit for each subgroup of interest (e.g., African American (Afr Am), obese, highly sensitive, 2^nd KTx, and pediatric recipients) and for deceased and living donors.

Results: 171,279 KTx (25.9% RDP) met inclusion criteria. RDP use increased from 3.1% in 2000 to 30.3% in 2014. Figure 1 gives the adjusted hazard ratios comparing RDP versus steroid use. Across all subgroups of 1^st KTx recipients, there was no significant association of RDP on DCGS; furthermore, RDP was associated with a significantly decreased hazard of death for recipients of DD KTx for Afr Am (HR = 0.91), the obese (HR = 0.88) and those with a primary disease which could re-occur in the transplanted kidney (HR = 0.85) with similar trends for recipients of LD KTx. However, in 2^nd DD KTx (but not 2^nd LD KTx) RDP was associated with a higher hazard of DC graft failure (HR = 1.25), with no significant difference in PS.

Conclusion: RDP may be used across a wide range of subpopulations of 1^st KTx recipients without risk of increased graft loss.

Figure 1: Comparison of steroid use for DCGS and PS by subgroups.

CITATION INFORMATION: Vock D., Matas A. Impact of Rapid Discontinuation of Prednisone on Kidney Transplant Outcomes in At-Risk Subpopulations: An OPTN/SRTR Analysis Am J Transplant. 2017;17 (suppl 3).

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