Preliminary results with early corticosteroid withdrawal in African American renal allograft recipients

The Rocky Road of Limited Immunosuppression for Renal Transplantation in African Americans

“…In short, longer term outcomes did not meet the expectations that were projected and expected by many from the initial report (1,32,33). The study, like most in African Americans, was small (35).…”

“…Subsequent studies from 2001 to 2004 using various combinations of TAC, SIR, and MMF retained corticosteroids as maintenance therapy in African Americans (28,30,31). However, later studies, some with and some without antibody-induction therapy, have challenged this seemingly insurmountable obstacle of corticosteroid withdrawal or avoidance in AA renal transplant recipients (32)(33)(34)(35). With the exception of just one of four protocols used in the Boardman study, all three of the steroid-avoidance protocols used antibody induction either as thymoglobulin (33,35) or basiliximab (34).…”

“…However, later studies, some with and some without antibody-induction therapy, have challenged this seemingly insurmountable obstacle of corticosteroid withdrawal or avoidance in AA renal transplant recipients (32)(33)(34)(35). With the exception of just one of four protocols used in the Boardman study, all three of the steroid-avoidance protocols used antibody induction either as thymoglobulin (33,35) or basiliximab (34). In the study of corticosteroid withdrawal three months after transplantation, no antibody induction was used (32,36).…”

Separate Reporting of Clinical Acute Rejection and Subclinical Acute Rejections in Kidney Transplantation

“…They retrospectively analyzed 47 patients and only six (12%) completed surveillance biopsy at one month and none of these six showed SCAR (8). In these papers, 84% and 88% of recipients did not have surveillance biopsies at one month and the true incidence of SCAR remains unknown (8,9). In these papers, 84% and 88% of recipients did not have surveillance biopsies at one month and the true incidence of SCAR remains unknown (8,9).…”

Conversion to Sirolimus in African American Renal Allograft Recipients Undergoing Early Steroid Withdrawal: Intermediate-Term Risks and Benefits

“…The authors mention that such an experience of CNI to SRL conversion has not been reported previously, but we have included such patients in a series of publications describing our outcomes with ESW in African American (AA) kidney transplant patients with multiple other high-risk factors (2)(3)(4) Patients received four doses of Thymoglobulin and methylprednisolone for induction, with mycophenolate mofetil 1 g twice daily and TCL (target trough levels 10 -12 ng/mL) for initial maintenance. Conversion to SRL was performed only for documented or probable CNI-related side effects in an overlap fashion identical to that described by the authors (1), with target trough levels 12 to 15 ng/mL in the first 6 months posttransplant, 10 to 12 ng/mL from 6 to 12 months, 8 to 10 ng/mL from 1 to 2 years, and 6 to 8 ng/mL thereafter.…”