Randomized prospective trial of early steroid withdrawal compared with low-dose steroids in renal transplant recipients using serial protocol biopsies to assess efficacy and safety

Laftavi, M. R.; Stephan, Rabie N.; Stefanick, Barbara; Kohli, R.; Dagher, Fadi; Applegate, Mary; O'Keefe, John Stewart; Pierce, Drew; Rubino, A; Guzowski, Haley; Leca, Nicolae; Dayton, Merril T.; Pankewycz, O.

doi:10.1016/j.surg.2004.10.013

Cited by 85 publications

(59 citation statements)

References 25 publications

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“…Multiple uncontrolled or retrospective investigations have suggested that early GC withdrawal does not jeopardize allograft or patient outcomes (59 -62). However, one prospective study that incorporated protocol kidney biopsy at 1 yr after transplantation demonstrated increased fibrosis in the early GC withdrawal group (63). Moreover, preliminary data from a large, multicenter, randomized, double-blind, controlled trial that evaluated early steroid withdrawal suggest that it may not reduce NODM, dyslipidemia, hypertension, or posttransplantation weight gain (64).…”

Section: Immunosuppression and Tahmentioning

confidence: 99%

Transplant-Associated Hyperglycemia

Crutchlow¹,

Bloom²

2007

Clinical Journal of the American Society of Nephrology

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New-onset diabetes has long been recognized as a common complication of kidney transplantation, promoting cardiovascular disease, death, and graft failure. Studies in recent years have begun to highlight the very high posttransplantation prevalence of the prediabetic states of impaired fasting glucose and impaired glucose tolerance and the significant repercussions of these states on cardiovascular health. Therefore, the overall burden of transplant-associated hyperglycemia (TAH), which encompasses new-onset diabetes and the prediabetic states, is far greater than previously appreciated. The kidney transplant population is predisposed to insulin resistance and to additional insults of hypertension and hyperlipidemia that, together with hyperglycemia, compose the metabolic syndrome and promote atherosclerosis. When recipients with an underlying, frequently nonmodifiable predisposition to glucose dysregulation encounter transplant-specific, often modifiable, diabetogenic exposures, TAH manifests. Aggressive screening will effectively detect TAH, whereas risk factor modification, lifestyle intervention, and, when appropriate, drug therapy may decrease its impact. Topics of future investigation should include the use of emerging diabetes therapies and avenues for the prevention and reversal of TAH.

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Section: Immunosuppression and Tahmentioning

confidence: 99%

Transplant-Associated Hyperglycemia

Crutchlow¹,

Bloom²

2007

Clinical Journal of the American Society of Nephrology

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“…Steroids do have antiinflammatory effects, and thus it is quite possible that they may mitigate interstitial scarring in the long term. In that regard, one single-center study examining serial protocol biopsies does suggest that interstitial scarring may be more frequent with steroid avoidance (73).…”

Section: Steroid Minimization: Discussionmentioning

confidence: 99%

Minimizing Immunosuppression, an Alternative Approach to Reducing Side Effects

Srinivas¹,

Meier‐Kriesche²

2008

Clinical Journal of the American Society of Nephrology

122

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Exceptionally low acute rejection rates and excellent graft survival can be achieved with cyclosporine and tacrolimus (CNI)-based immunosuppressive protocols that incorporate antiproliferative immunosuppressants and corticosteroids. However, despite short-term success, long-term attrition of graft function and side effects of immunosuppressive agents continue to be significant problems, leaving clinicians looking for possible interventions. CNI nephrotoxicity is but one of numerous factors that may contribute to long-term damage in transplant kidneys. Metabolic, cosmetic, and neuropsychiatric complications of steroids affect quality of life after transplantation. Newer immunosuppressive agents such as mycophenolate mofetil and sirolimus (Rapa) have raised the possibility of withdrawing or avoiding CNIs or steroids altogether. In this report we review studies that address either CNI or steroid minimization strategies and discuss their risks versus benefits. Given the accumulated experience to date, in our opinion the use of CNIs and steroids as part of immunosuppressive regimens remains the proven standard of care for renal transplant patients. The long-term safety and efficacy of CNI and steroid minimization strategies needs to be further validated in controlled clinical trials with adequate long-term follow-up.

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“…At a 12 months follow up, there was no variation in graft performance and rate of AR amongst the 2 groups. Interstitial fi brosis was, however, prominent in biopsies at 12 months in the withdrawal group [7,33].…”

Section: Steroid Avoidancementioning

confidence: 92%

Defining a Steroid Withdrawal Protocol in a newly established Kidney Transplantation Unit

Halawa¹

2017

Arch Organ Transplant

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Randomized prospective trial of early steroid withdrawal compared with low-dose steroids in renal transplant recipients using serial protocol biopsies to assess efficacy and safety

Cited by 85 publications

References 25 publications

Transplant-Associated Hyperglycemia

Transplant-Associated Hyperglycemia

Minimizing Immunosuppression, an Alternative Approach to Reducing Side Effects

Defining a Steroid Withdrawal Protocol in a newly established Kidney Transplantation Unit

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