Date: Monday, June 4, 2018
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall 4EF
In kidney transplantation, donor-recipient HLA-DR mismatch poses high immunologic risk and is associated with inferior outcomes. We aimed to explore the impact of enhanced immunosuppression with chronic steroid maintenance (CSM) on the long-term outcomes in kidney transplant recipients (KTx) with varying levels of donor-recipient HLA-DR mismatches. Using the OPTN/UNOS data base, we identified adult kidney only transplant recipients from 2001-2015, who received induction therapy and were discharged on calcineurine inhibitor/mycophenolic acid (CNI/MMF) based maintenance immunosuppression with or without steroids. Patients were then stratified by the number of donor-recipient HLA-DR mismatches (0,1,2) in both living donor kidney (LDKR) and deceased donor kidney (DDKR) transplant recipients. Using a Cox model adjusting for donor, transplant and recipient factors, overall and death-censored graft failure risks along with patient death risk were compared for CSM vs. early steroid withdrawal under each HLA-DR mismatch category in LDKR and DDKR groups. Results are shown in Table 1.
|Living Donor Transplant||Deceased Donor Transplant|
|Number of HLA-DR mismatches||0||1||2||0||1||2|
|Chonic steroid maintenance (n)||4,451||12,474||6,809||10,020||20,134||17,046|
|Early steroid Withdrawal (n)||2,494||7,103||3,916||3,895||7,860||5,967|
|Adjusted overall graft failure risk (HR with 95%CI)||1.19 (1.04-1.37) *||1.07 (0.99-1.15)||1.03 (0.93-1.14)||1.09 (1.01-1.19)*||1.06 (1.00-1.12)*||1.02 (p.96-1.08)|
|Adjusted death censored graft failure risk (HR with 95%CI)||1.05 (0.86- 1.27)||0.95 (0.86- 1.05 )||0.91 (0.80-1.03)||0.94 (0.83-1.05)||1.02 (0.95- 1.10)||0.92 (0.85-0.99)*|
|Adjusted patient death risk (HR with 95%CI)||1.26 (1.06-1.50)*||1.19 (1.08-1.30)***||1.12 (0.98-1.28)||1.22 (1.10- 1.35)***||1.11 (1.04-1.18)**||1.15 (1.07- 1.23)***|
|p value: *= <0.05, **= <0.005, ***= <0.0001|
Our study did not show benefit of CSM in KTx at different levels of donor-recipient HLA-DR mismatches who received induction and were discharged on CNI/MMF maintenance. Adverse patient outcomes associated with CSM in LDKR with 0-1 HLA-DR mismatches and DDKR with all levels of mismatches could reflect consequences of enhanced immunosuppression. Retrospective study design and possibility of residual confounding are study limitations.
CITATION INFORMATION: Chopra B., Sureshkumar K. Impact of Steroid Maintenance on the Outcomes of HLA-DR Mismatch Kidney Transplantation Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:Chopra B, Sureshkumar K. Impact of Steroid Maintenance on the Outcomes of HLA-DR Mismatch Kidney Transplantation [abstract]. https://atcmeetingabstracts.com/abstract/impact-of-steroid-maintenance-on-the-outcomes-of-hla-dr-mismatch-kidney-transplantation/. Accessed October 28, 2020.
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