The success of continued steroid avoidance after kidney transplantation in the US

J. D. Schold, A. Santos, Shehzad Rehman, J. Magliocca, H. U. Meier-Kriesche

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

There has been a significant increase in the use of steroid avoidance regimens as initial treatment for kidney transplant recipients. Early results of the effectiveness of this strategy has been mixed with certain prospective trials indicating increased acute rejection but population-based studies indicating similar or better graft survival as compared to steroid maintenance. We conducted a retrospective study of national registry data to evaluate risk factors for discontinuation of steroid avoidance protocols based on patient characteristics and concomitant immunosuppression. We evaluated 84 647 solitary kidney transplant recipients in the US with at least 6 months graft survival including 24 218 initially discharged without maintenance steroids. We utilized logistic models to assess risk factors for new initiation of steroids after initial steroid-avoidance and survival models to describe graft survival for patients after return to steroids. The most prominent risk factors for new initiation of steroids after deceased donor kidney transplantation included African-American race (AOR = 1.32, p < 0.01), retransplants (AOR = 1.81, p < 0.01), highly sensitized recipients (AOR = 1.29, p < 0.01), recipients with Medicaid (AOR = 1.85, p < 0.01), elevated HLA-MM (AOR = 1.26, p < 0.01) and older donor age (AOR = 1.19, p < 0.01). Concomitant medications were also significantly associated with the propensity to newly initiate steroids. Cumulatively the study suggests that both patient characteristics and concomitant medications are strongly associated with the success of steroid avoidance immunosuppressive regimens.

Original languageEnglish (US)
Pages (from-to)2768-2776
Number of pages9
JournalAmerican Journal of Transplantation
Volume9
Issue number12
DOIs
StatePublished - Dec 1 2009
Externally publishedYes

Fingerprint

Kidney Transplantation
Steroids
Graft Survival
Maintenance
Tissue Donors
Kidney
Medicaid
Immunosuppressive Agents
African Americans
Immunosuppression
Registries
Retrospective Studies
Logistic Models
Survival

Keywords

  • Immunosuppressive regimens
  • Kidney transplantation
  • Outcomes
  • Steroid avoidance

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

Cite this

The success of continued steroid avoidance after kidney transplantation in the US. / Schold, J. D.; Santos, A.; Rehman, Shehzad; Magliocca, J.; Meier-Kriesche, H. U.

In: American Journal of Transplantation, Vol. 9, No. 12, 01.12.2009, p. 2768-2776.

Research output: Contribution to journalArticle

Schold, J. D. ; Santos, A. ; Rehman, Shehzad ; Magliocca, J. ; Meier-Kriesche, H. U. / The success of continued steroid avoidance after kidney transplantation in the US. In: American Journal of Transplantation. 2009 ; Vol. 9, No. 12. pp. 2768-2776.
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