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Multicenter Study
. 2022 Mar;10(3):e576.
doi: 10.1002/iid3.576. Epub 2021 Dec 15.

Safety and metabolic advantages of steroid withdrawal after 6 months posttransplant in de novo kidney transplantation: A 1-year prospective cohort study

Jun B Bang  1 , Chang-Kwon Oh  1 , Yu S Kim  2 , Sung H Kim  3 , Hee C Yu  4 , Chan-Duck Kim  5 , Man Ki Ju  6 , Byung J So  7 , Sang Ho Lee  8 , Sang Y Han  9 , Cheol W Jung  10 , Joong K Kim  11 , Hyung J Ahn  12 , Su H Lee  1 , Ja Y Jeon  13
Affiliations
Multicenter Study

Safety and metabolic advantages of steroid withdrawal after 6 months posttransplant in de novo kidney transplantation: A 1-year prospective cohort study

Jun B Bang et al. Immun Inflamm Dis. 2022 Mar.

Abstract

Introduction: This prospective multicenter study aimed at investigating the safety and metabolic advantages of steroid withdrawal (SW) therapy in kidney transplant recipients with tacrolimus-mycophenolate mofetil-based immunosuppression.

Methods: We analyzed 179 recipients who received kidney transplantation from March 2016 and September 2018. In 179 recipients, 114 patients maintained an immunosuppressive regimen including steroids (steroid continuation [SC] group). The remaining 65 patients were determined to withdraw steroid therapy after 6 months posttransplant (SW group). Metabolic parameters and graft functions of the two groups were evaluated.

Results: The estimated glomerular filtration rates at 12 months posttransplant were 67.29 ± 20.29 ml/min/1.73 m2 in SC group and 73.72 ± 17.57 ml/min/1.73 m2 in SW group (p < .001). The acute rejection occurred to four recipients in the SC group (3.5%) and no acute rejection occurred to SW group recipients during the 6-2 months posttransplant period. Oral glucose tolerance tests revealed that recipients in the SW group were more improved in glucose metabolism than the SC group during 6-12 months posttransplant. In addition, cholesterol levels and blood pressure decreased after the withdrawal of steroids in the SW group.

Conclusion: In conclusion, a 6-month withdrawal of steroids in recipients with low immunological risk and stable graft function can be safely conducted and result in improvement of metabolic profiles. Stable recipients without biopsy-proven acute rejection and proteinuria can safely withdraw from steroids out of a maintenance immunosuppressive regimen 6-months posttransplant. A long-term follow-up study is needed to verify our results.

Keywords: cholesterol; glucose tolerance test; kidney transplantation; steroids.

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Conflict of interest statement

The authors declare that there are no conflict of interests.

Figures

Figure 1
Figure 1
Patient's flowchart. BPAR, biopsy‐proven acute rejection
Figure 2
Figure 2
The incidence of new‐onset diabetes after transplantation (NODAT) during the follow‐up period in two groups
Figure 3
Figure 3
The comparison of glucose metabolism parameters between steroid continuation (SC) and steroid withdrawal (SW) groups
See this image and copyright information in PMC

References

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