RDP (prednisone [P] discontinuation <7 days posttx) is associated with ↑ rates of mild AR, ⇓ P-related side effects, better CVD risk profile, and no diff in patient or graft survival. We studied posttx cardiac (C) events in adult, 1st kidney tx treated with RDP (n=1362) vs historical controls on maintenance P (n=459). All were treated with Ab induction, CNI, and MMF or SRL. By MVA, risk factors for C events included control group, age ≥ 50, and pretx dialysis (dial), diabetes (diab), or C morbidity (p≤ .004). There was an interaction between pretx diab and pretx C morbidity (Table 1).
|RDP *(vs control)||0.5 (0.4-0.6)||<.0001|
|Pre tx dial (vs no)||1.5 (1.1-1.9)||.004|
|Age ≥ 50 (vs <50)||1.7 (1.4-2.1)||<.0001|
|Nondiab, pretx C (vs nondiab, no pretx C)||4.2 (3.0-5.8)||<.0001|
|Diab, no pretx C (vs nondiab, no pretx C)||2.8 (2.0-3.9)||<.0001|
|Diab, pretx C (vs nondiab, no pretx C)||5.6 (4.2-7.3)||<.0001|
RDP-treated recips had lower C event rates (9 year actuarial, event-free rate: RDP=76%, controls=63% [p<.0001]) and lower C death rates (9 year, event-free rate: RDP=95%, controls=90% [p<.0001]).
Differences between RDP and controls in C event-free rates varied by subgroup (Table 2). There was no diff for those w/o pretx C (Diab or nonDiab) except for nondiab ≥50 on dial (sig ⇓ with RDP). Those with pretx C and treated with RDP had significantly lower C event rates (except diab on dial). When "stroke" was included as an event, the results were similar (data not shown).
Our data suggests that for recips with pretx cardiac morbiditity, RDP is associated with lower posttx cardiac event rates; a confirmatory randomized trial would be ideal.
|# at risk/% survival|
|Nondiab, no pretx C, no dial||20/95%||142/96%||NS|
|no pretx C, dial||103/90%||204/91%||NS|
|pretx C, no dial||– –||5/80%|
|pretx c, dial||24/59%||37/86%||.02|
|Diab, no pretx c, no dial||6/83%||39/79%||NS|
|no pretx C, dial||30/88%||92/74%||NS|
|pretx C, no dial||11/32%||28/73%||.04|
|pretx C, dial||48/33%||100/65%||.001|
|Nondiab, no pretx C, no dial||8/100%||100/90%||NS|
|no pretx C, dial||73/68%||161/86%||.003|
|pretx C, no dial||3/33%||28/70%||.01|
|pretx C, dial||42/32%||74/60%||.01|
|Diab, no pretx C, no dial||2/100%||44/87%<
To cite this abstract in AMA style:Matas A, Gillingham K, Ibrahim H. Posttransplant Cardiac Event Rates Are Lower with Rapid Discontinuation of Prednisone (RDP) [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/posttransplant-cardiac-event-rates-are-lower-with-rapid-discontinuation-of-prednisone-rdp/. Accessed October 20, 2020.
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