Corticosteroids withdrawal in renal grafted patients: follow-up and outcome
Manuel Rengel1, Lorena Tana1, Facundo Humacata1, Almudena Vega1, Úrsula Verdalles1, Soraya Abad1, Nicolás Macías1, Eduardo Verde1.
1Nephrology, Hospital General Universitario "Gregorio Marañón", Madrid, Spain
Introduction: Corticosteroids are powerful antiinflamatory with immunosuppressant effects utilized in maintenance therapy following kidney transplantation and are associated with a higher rate of side events in comparison with protocols involving early corticosteroid withdrawl. The present paper reports the results of cessation of steroids in stable maintenance renal transplant patients.
Patients and methods: One hundred sixty seven deceased kidney grafted patients (54% men), aged 57.5±12.4 years, with follow-up of 84 months and steroids withdrawl period of 60 months (1-198) follow-up steroid free were studied. Etiology of end stage renal disease was secondary to Glomerulonephritis 31%, Diabetes 22%, Policystic disease 14%, Tubulointerstitial nephropathy 13%, Vascular 5%, Unknown 17%. The patients were on Prednisone 5-10 mg dairy combined with Cyclosporine 50-150 mg/Tacrolimus 0.5-6 mg, associate to Mycophenolate Mophetyl 250-2.000 mg, Sodium Micophenolate, 360-900 mg or Azatioprine 50-75 mg, and Everolimus 1-4 mg. Steroids were diminished gradually in three months period and some patients receibe monotherapy only.
Results: Basal serum creatinine was 1.54±0.6mg/dl and after five years followup 1.4±0.5 mg/dl. Basal blood glucose concentration was 130±12 mg/dl and after five years 109±0.8mg/dl. Weight was maintained. At 5 years, graft and patient survival were 100%. There was no acute rejection after steroids withdrawl. After withdrawl blood pressure control was achieved with less antihypertensive drugs. Lipids diminished slightly with less cholesterol-lowering drugs.
Conclusion: Corticosteroids could be withdrawn safely in stable renal transplant patients and avoid morbidity and adverse events related to chronic utilization improving survival and quality of life.
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