Prednisone-free maintenance immunosuppression - A 5-year experience

Arthur J. Matas, Raja Kandaswamy, Kristen J. Gillingham, Lois McHugh, Hassan Ibrahim, Bertram Kasiske, Abhinav Humar

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127 Scopus citations

Abstract

Concern persists that prednisone-free maintenance immunosuppression in kidney transplant recipients will be associated with an increase in late allograft dysfunction and graft loss. We herein report 5-year follow-up of a trial of prednisone-free maintenance immunosuppression. From October 1, 1999, through January 31, 2005, at our center, 589 kidney transplant recipients were treated with a protocol incorporating discontinuation of their prednisone on postoperative day 6. At 5 years, actuarial patient survival was 91%; graft survival, 84%; death-censored graft survival, 92%; acute rejection-free graft survival, 84% and chronic rejection-free graft survival, 87%. The mean serum creatinine level (±SD) at 1 year was 1.6 ± 0.6; at 5 years, 1.7 ± 0.8. In all, 86% of kidney recipients with functioning grafts remain prednisone-free as of April 30, 2005. As compared with historical controls, recipients on prednisone-free maintenance immunosuppression had a significantly lower rate of a number of complications, including cataracts (p < 0.001), posttransplant diabetes mellitus (p < 0.001), avascular necrosis (p = 0.001), and fractures (p = 0.004). We conclude that prednisone-related side effects can be minimized in a protocol incorporating prednisone-free maintenance immunosuppression. Five-year graft outcome remains good.

Original languageEnglish (US)
Pages (from-to)2473-2478
Number of pages6
JournalAmerican Journal of Transplantation
Volume5
Issue number10
DOIs
StatePublished - Oct 2005

Keywords

  • Kidney transplantation
  • Prednisone-free maintenance immunosuppression

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