Intermediate-term outcomes with early steroid withdrawal in African-American renal transplant recipients undergoing surveillance biopsy
| Autor: | Jose M. El-Amm, Scott A. Gruber, Elizabeth Cincotta, M. West, Julian E. Losanoff, Atul Singh, Mona D. Doshi, Katherina Morawski, Xu Zeng |
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| Rok vydání: | 2007 |
| Předmět: |
Adult
Graft Rejection medicine.medical_specialty Biopsy chemistry.chemical_compound Chronic allograft nephropathy Adrenal Cortex Hormones Risk Factors medicine Humans Transplantation Homologous Kidney transplantation Retrospective Studies Immunosuppression Therapy Creatinine Thymoglobulin business.industry Incidence Graft Survival Middle Aged medicine.disease Kidney Transplantation Tacrolimus Surgery Calcineurin Transplantation Black or African American Treatment Outcome chemistry Sirolimus Acute Disease business medicine.drug Follow-Up Studies |
| Zdroj: | Surgery. 142(4) |
| ISSN: | 0039-6060 |
| Popis: | There is a paucity of data regarding the use of early corticosteroid withdrawal (ESW) in African-American renal allograft recipients, and very few reports withor=1 year follow-up in all patients.We examined the outcomes of 57 African-American renal allograft recipients with minimum follow-up 12 months who did not receive maintenance steroids after day 4 posttransplant. All patients received thymoglobulin induction, mycophenolate mofetil, and initial tacrolimus (n = 48) or sirolimus (n = 9).Patient and graft survival were 98% and 96% at 1 year, and 95% and 89% over the entire follow-up period (mean, 23 +/- 8 months). Incidence of acute rejection and cytomegalovirus infection were 18% and 7%, respectively, with mean serum creatinine 1.6 +/- 0.5 and 1.7 +/- 0.9 mg/dL at 6 and 12 months. Of patients with functioning grafts, 84% remained steroid free at 1 year, of which 11 (24%) were also calcineurin inhibitor free. Twenty-seven patients underwent surveillance biopsy at 1 month and 28 at 12 months, with 15 surveyed at both time points. There were significant increases in only 2 of the 6 1997 Banff chronic allograft nephropathy (CAN) category scores in this subgroup, with all mean values remaining1 (mild in severity) at 1 year. Overall, from 82% to 96% of the 12-month scores wereor=1 in all categories for 28 patients; only 3 patients (11%) had interstitial fibrosis and tubular atrophy scores at least moderate in severity. We did not observe any cases of subclinical acute rejection.Our findings suggest that ESW in African-American renal allograft recipients with multiple high-risk factors can produce excellent intermediate-term antirejection and graft functional outcomes with minimal development of CAN at 12 months. Our results will need to be verified in larger numbers of patients with longer follow-up. |
| Databáze: | OpenAIRE |
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