Steroid Withdrawal and De Novo Donor-Specific HLA Antibodies in Renal Transplant Patients: A Prospective, Randomized, Controlled Study in Parallel Groups. Preliminary Results.
1Nephrology, Regional University Hospital and Malaga University, IBIMA, RD16/0009/0006, Malaga, Spain
2Immunology, Regional University Hospital, Malaga, Spain
3Pathology, Regional University Hospital, Malaga, Spain
4Nephrology, Hospital Universitario de Canarias, CIBICAN, University of La Laguna, RD16/0009/0031, Tenerife, Spain
5Nephrology, IDIBELL, Hospital de Bellvitge, RD16/0009/0003, Barcelona, Spain
6Nephrology, Hospital Universitari Vall d'Hebron, RD 16/0009/0030, Barcelona, Spain
Meeting: 2017 American Transplant Congress
Abstract number: A10
Keywords: Antibodies, Immunosuppression, Kidney transplantation
Session Information
Session Name: Poster Session A: Antibody Mediated Rejection in Kidney Transplant Recipients I
Session Type: Poster Session
Date: Saturday, April 29, 2017
Session Time: 5:30pm-7:30pm
Presentation Time: 5:30pm-7:30pm
Location: Hall D1
Introduction: Steroids represent a mainstay of immunosuppression after kidney transplant (KT). Steroid withdrawal reduces metabolic and cardiovascular complications, but whether it increases the risk of acute rejection and the generation of donor-specific anti-HLA antibodies (DSA) is undetermined.
Material and methods: In a controlled clinical trial (NCT02284464) 176 KT patients with low immunological risk were recruited to randomly receive either conventional triple immunosuppression: steroids, TAC and MMF versus steroid withdrawal at post-KT month 3. We compared the incidence of de novo DSA (Luminex Mixed and Luminex Single Antigen -One Lambda), and its impact on graft histology in patients with steroid withdrawal at post-KT month 3 (after a protocol biopsy) versus patients who continue to receive conventional triple immunosuppression.
Results: So far, 68 patients have been randomized (34 per group), with no significant differences in the clinical and demographic characteristics between the groups. The intermediate analysis in those patients who had completed one year of follow-up (n=28) showed no significant differences in the formation of DSA (0% vs. 0%), nor was there rejection in those patients in whom prednisone was withdrawn after randomization. Patients with triple therapy showed a trend toward better renal function compared to those without steroids at the first post-KT year (1.29±0.25 vs. 1.56±0.42 mg/dL, P=.088). HbA1c levels were similar between both groups at the first post-KT year (5.79±0.59 vs. 5.68±0.81%, P=.734).
Conclusion: The preliminary results show that steroid withdrawal at post-KT month 3 seems safe regarding the appearance of rejection and formation of DSA compared to the patients who continued to receive conventional triple immunosuppression.
CITATION INFORMATION: Alonso-Titos J, Ruiz-Esteban P, Palma E, Lopez V, Caballero A, Leon M, Cobos M, Cruzado J, Sellares J, Torres A, Hernandez D. Steroid Withdrawal and De Novo Donor-Specific HLA Antibodies in Renal Transplant Patients: A Prospective, Randomized, Controlled Study in Parallel Groups. Preliminary Results. Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Alonso-Titos J, Ruiz-Esteban P, Palma E, Lopez V, Caballero A, Leon M, Cobos M, Cruzado J, Sellares J, Torres A, Hernandez D. Steroid Withdrawal and De Novo Donor-Specific HLA Antibodies in Renal Transplant Patients: A Prospective, Randomized, Controlled Study in Parallel Groups. Preliminary Results. [abstract]. Am J Transplant. 2017; 17 (suppl 3). https://atcmeetingabstracts.com/abstract/steroid-withdrawal-and-de-novo-donor-specific-hla-antibodies-in-renal-transplant-patients-a-prospective-randomized-controlled-study-in-parallel-groups-preliminary-results/. Accessed May 14, 2025.« Back to 2017 American Transplant Congress