Background: Steroids are often used as part of standard immunosuppressant therapy to help prevent acute rejection in renal transplant patients. However, the long term adverse effects of steroids are well known. We hypothesized that early steroid withdrawal (ESW) is safe and effective in HLA matched kidney transplant recipients (KTR).

Methods: Data from 6 antigen matched patients transplanted between 1994 and 2013 were analyzed to determine the effect of early steroid withdrawal on overall graft survival and kidney function at 12 months.

Results: A total of 278 KTR with 6 antigen HLA match were identified. Eighty-eight patients were determined to have had ESW, defined as steroids discontinued within three weeks after transplant. There was no difference between patients who received ESW compared to those who did not based on age, gender, or ethnicity. Those who received ESW were less likely to have had delayed graft function (0 vs 10%, respectively, p = 0.002).

Acute rejection occurred in 5.6% of those who received ESW and 2.6% of those that who did not. The incidence rate for acute rejection was 0.58 in ESW and 0.32 in steroid continuation (SC) per 100 person years (p = 0.36). Death censored graft loss occurred in 13.6% of those who received ESW and 18.42% of those who did not, and the incidence rate was revealed to be 1.37 and 2.21 per 100 person-years, respectively (p = 0.15). The mean serum creatinine at 12 months was 1.38 mg/dl for ESW and 1.45 mg/dl for SC (p = 0.30), and the mean GFR at 12 months was 56.71 mL/min and 58.13 mL/min, respectively (p = 0.55). Infection of any kind was reported in 70.4% of those who received ESW and 71.1% of those who did not. The incidence rate of infection per 100 person years was lower in the ESW group than the SC group (14.8 vs 23.93 per 100 person-years; p=0.001).

Conclusions: In 6 antigen matched KTR, ESW was not significantly associated with differences in overall graft survival or kidney function at 12 months. ESW may be considered a viable option for these patients in conjunction with other patient specific factors.

CITATION INFORMATION: Champion H., Holdener K., Astor B., Aziz F., Mandelbrot D. Outcomes of Early Steroid Withdrawal in 6-Antigen Human Leukocyte Antigen (HLA)-Matched Kidney Transplant Recipients Am J Transplant. 2017;17 (suppl 3).

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