Withdrawal of steroids from triple‐drug therapy in kidney transplant patients (original) (raw)

2000, Nephrology Dialysis …

Introduction Background. In renal transplant patients with stable graft function, triple-drug immunosuppression may Triple-drug therapy is the most widely used regimen not be necessary, while withdrawal of steroids may in kidney transplantation [1], but no benefit of its eliminate side effects. The primary aim of this study long-term use has been demonstrated, and it may be was to assess the risk of rejection after steroid unnecessary in most patients. Because of their side withdrawal. effects, steroids are the first candidate to be removed Methods. A total of 88 patients with stable graft from the immunosuppressive regimen. Steroid-free function and serum creatinine <160 mmol/l, treated therapy would be beneficial for particular groups of with cyclosporin A, azathioprine and prednisone were patients such as children [2], elderly [3], diabetics [4], randomized into group A (n=46) with a gradual patients with osteoporosis [5] and hyperlipidaemia [6 ]. prednisone reduction to zero in the course of 6 months, The main risk associated with steroid withdrawal is and group B (n=42) on triple-drug therapy without rejection [7]. One of the important factors is the timing change. At the time of randomization, fine-needle of steroid withdrawal [7]. aspiration biopsy (FNAB) was carried out in all of The aim of this project was to assess the risk for the patients. After stopping steroids, the patients were rejection in a controlled study where steroids were followed up for a period of 12 months. withdrawn 1 year after transplantation, employing Results. Four patients failed to complete steroid withfine-needle aspiration biopsy (FNAB) as a possible drawal, three due to rejection, and one due to leukopredictor of rejection. penia. The proportion of rejection in three patients in group A (6.6%) was not significantly different from rejection in two patients in group B (4.8%). The mean Subjects and methods value of serum creatinine was not significantly different in both groups in the course of follow-up. A finding Eighty-eight patients after their first kidney transplantation, of some degree of immunological activity in FNAB with stabilized graft function, and serum creatinine under was made in four patients in each group, but none of 160 mmol/l, treated with cyclosporine A, azathioprine and these patients developed rejection. Compared with prednisone were randomized, according to the month of group B, significant decreases in serum cholesterol and birth, into a withdrawal group (A, n=46), and a control blood leukocytes were observed in group A. Prednisone group (B, n=42). Only one graft for the patient in group B was from living donor, 87 grafts were from cadaverous withdrawal did not have any influence on hypertension donors. There was no statistical difference in the main and serum triglycerides. characteristic features (Table 1) between both groups. Conclusions. Gradual withdrawal of steroids is not In patients of group A, prednisone was gradually withassociated with a higher risk for rejection and has a drawn over a period of 6 months, while the dose of cyclospobeneficial effect on serum total cholesterol levels. rin A was adjusted to keep whole blood levels in the upper FNAB was not a useful tool for predicting rejection. half of the therapeutic range, and azathioprine dose on a minimum of 1.5 mg/kg/day. The immunosuppressive proto-Keywords: fine-needle aspiration biopsy; immunocol in patients of group B was not changed. Duration of suppressive treatment; kidney transplantation; follow-up after stopping steroids was 12 months. rejection; steroid withdrawal; triple-drug therapy Rejection was suspected, when serum creatinine increased more than 30 mmol/l. All rejections were confirmed by biopsy assessed according to Banff classification. FNAB was carried out in a modification after Häyry and