Discontinuation of steroids in ABO-incompatible renal transplantation

Abstract

SUMMARYA steroid-free protocol for ABO-compatible renal transplantation has been used at our center since 1983. To minimize the adverse effects of steroids, we also developed a steroid sparing protocol for ABO-incompatible renal transplantation in 2008. The present study is a report of our results. A retrospective review of the first 50 ABO-incompatible renal transplantations performed at a single university center. If no immunological events occurred in the post-transplant period, prednisolone tapering was initiated approximately 3 months after transplantation. Forty-three patients completed prednisolone tapering after 289 AE 58 days. Three patients died during follow-up, and four patients lost graft function. None of these adverse events were rejection related. Eleven patients experienced rejections; seven were on prednisolone and four were after weaning from prednisolone. All patients responded well to antirejection treatment. Overall, 1-year rejection rate was 19%. One-and 3-year graft survival was 94% and 91%, respectively. One-year post-transplant median serum creatinine was 123 lmol/L. We found acceptable rejection rates, graft survival, and creatinine levels in patients undergoing ABO-incompatible renal transplantations with a steroid sparing protocol. However, a longer follow-up of a lager cohort is needed before firm conclusions can be made.

A case of successful late steroid withdrawal after ABO-incompatible kidney transplantation

“…This 55% rejection rate was relatively high compared with early steroid withdrawal (30%–40%). Conversely, Novosel and Bistrup [ 1 ] reported optimistic results of steroid withdrawal. Their retrospective, single-center study showed successful steroid withdrawal in 86% of patients after 289 days and 1-year rejection rate of 19% without protocol biopsy.…”

“…Recently, ABO-incompatible (ABO-i) KT has started to be applied across worldwide. However, limited data existing regarding steroid withdrawal after ABO-i KT show a higher rejection rate, from 7% to 55% [1][2][3][4]. These differences may have been affected by the differences in immunosuppressive regimen and/or time of steroid withdrawal, and presence or absence of protocol biopsy.…”

Conquering immunological barrier in kidney transplantation: ABO incompatible transplantation

“…The basal immunosuppression is initiated together with the desensitization. The suppression of B-cells by Tacrolimus, Mycophenolate mofetil, and steroids seems to be vital for antibody suppression and eventual s u p p r e s s i o n o f a c u t e A B M R i n A B O -I L K T recipients (26).The augmented risk of acute rejection upon early or late steroid withdrawal is well documented (27,28). Overall, patients receiving transplant involving ABOi are not allowed to reduce immunosuppression.…”

Steroid avoidance/withdrawal and maintenance immunosuppression in pediatric kidney transplantation

“…Small, single-center, retrospectives studies have described successful use of SW in this setting, with rejection rates ranging between 9% and 30% following late or early SW, respectively. [62][63][64][65][66] In a retrospective study of 50 adult ABO-incompatible kidney transplant recipients, Novosel et al 67 described 1-and 3-year GS of 94% and 91%, respectively, when SW was initiated 3 months after transplant.…”