Outcome at 3 years with a prednisone-free maintenance regimen: A single-center experience with 349 kidney transplant recipients

Khalid Khwaja, Massimo Asolati, James Harmon, J. Keith Melancon, Ty Dunn, Kristen Gillingham, Raja Kandaswamy, Abhinav Humar, Rainer Gruessner, William Payne, John Najarian, David Dunn, David Sutherland, Arthur J. Matas

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91 Scopus citations


Historically, late steroid withdrawal after kidney transplants has been associated with an increased rejection rate. Recently, low rejection rates have been reported for recipients treated with complete avoidance or rapid elimination of steroids. However, follow-up has been short. We herein report on 3-year outcome in recipients whose prednisone was rapidly eliminated and who were maintained on a steroid-free regimen. From 10/1/1999 through 5/1/2003, 349 recipients (254 LD, 95 CAD; 319 in first 30 s) were immunosuppressed with polyclonal antibody (Thymoglobulin), a calcineurin inhibitor, either mycophenolate mofetil or sirolimus, and rapid discontinuation of prednisone. Actuarial 3-year patient survival was 95%; graft survival, 93%. Acute rejection-free graft survival at 1 year was 94%; at 3 years, 92%. There was no difference between LD and CAD. At 2 years, the mean (± SE) serum creatinine level for LDs was 1.6 ± 0.5 mg/dL; for CAD, 1.6 ± 0.4 mg/dL. We have no new cases of PTLD or avascular necrosis; 22 recipients (6%) developed CMV. Currently, 84% of recipients remain prednisone-free. We conclude that excellent 3-year patient and graft survival can be achieved without maintenance prednisone. With such a protocol, steroid-related side-effects are minimal.

Original languageEnglish (US)
Pages (from-to)980-987
Number of pages8
JournalAmerican Journal of Transplantation
Issue number6
StatePublished - Jun 2004

Bibliographical note

Funding Information:
I am grateful to the British Ecological Society (BES) for funding this research. I thank the Faculty of Forestry and Nature Conservation, Makerere University and the Institute of Tropical Forest Conservation (ITFC) for support during the fieldwork. I am grateful to the Pygmy resource persons who identified the bees using folk taxonomy.


  • Kidney transplant
  • Steroid-free


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