Rapid Discontinuation of Prednisone in Kidney Transplant Recipients

15-Year Outcomes from the University of Minnesota

Oscar Serrano, Raja Kandaswamy, Kristen Gillingham, Srinath Chinnakotla, Ty B Dunn, Erik B Finger, William D Payne, Hassan Ibrahim, Aleksandra Kukla, Richard S Spong, Naim Issa, Timothy L Pruett, Arthur J Matas

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background Short- A nd intermediate-term results have been reported after rapid discontinuation of prednisone (RDP) in kidney transplant recipients. Yet there has been residual concern about late graft failure in the absence of maintenance prednisone. Methods From October 1, 1999, through June 1, 2015, we performed a total of 1553 adult first and second kidney transplants-1021 with a living donor, 532 with a deceased donor-under our RDP protocol. We analyzed the 15-year actuarial overall patient survival (PS), graft survival (GS), death-censored GS (DCGS), and acute rejection-free survival (ARFS) rates for RDP compared with historical controls on maintenance prednisone. Results For living donor recipients, the actuarial 15-year PS rates were similar between groups. But RDP was associated with increased GS (P = 0.02) and DCGS (P = 0.01). For deceased donor recipients, RDP was associated with significantly better PS (P < 0.01), GS (P < 0.01) and DCGS (P < 0.01). There was no difference between groups in the rate of acute or chronic rejection, or in the mean estimated glomerular filtration rate at 15 years. However, RDP-treated recipients had significantly lower rates of avascular necrosis, cytomegalovirus, cataracts, new-onset diabetes after transplant, and cardiac complications. Importantly, for recipients with GS longer than 5 years, there was no difference between groups in subsequent actuarial PS, GS, and DCGS. Conclusions In summary, at 15 years postkidney transplant, RDP did not lead to decreased in PS or GS, or an increase in graft dysfunction but as associated with reduced complication rates.

Original languageEnglish (US)
Pages (from-to)2590-2598
Number of pages9
JournalTransplantation
Volume101
Issue number10
DOIs
StatePublished - Oct 1 2017

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Prednisone
Graft Survival
Kidney
Transplants
Survival
Living Donors
Survival Rate
Maintenance
Tissue Donors
Transplant Recipients
Cytomegalovirus
Glomerular Filtration Rate
Cataract
Necrosis

PubMed: MeSH publication types

  • Journal Article

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Rapid Discontinuation of Prednisone in Kidney Transplant Recipients : 15-Year Outcomes from the University of Minnesota. / Serrano, Oscar; Kandaswamy, Raja; Gillingham, Kristen; Chinnakotla, Srinath; Dunn, Ty B; Finger, Erik B; Payne, William D; Ibrahim, Hassan; Kukla, Aleksandra; Spong, Richard S; Issa, Naim; Pruett, Timothy L; Matas, Arthur J.

In: Transplantation, Vol. 101, No. 10, 01.10.2017, p. 2590-2598.

Research output: Contribution to journalArticle

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abstract = "Background Short- A nd intermediate-term results have been reported after rapid discontinuation of prednisone (RDP) in kidney transplant recipients. Yet there has been residual concern about late graft failure in the absence of maintenance prednisone. Methods From October 1, 1999, through June 1, 2015, we performed a total of 1553 adult first and second kidney transplants-1021 with a living donor, 532 with a deceased donor-under our RDP protocol. We analyzed the 15-year actuarial overall patient survival (PS), graft survival (GS), death-censored GS (DCGS), and acute rejection-free survival (ARFS) rates for RDP compared with historical controls on maintenance prednisone. Results For living donor recipients, the actuarial 15-year PS rates were similar between groups. But RDP was associated with increased GS (P = 0.02) and DCGS (P = 0.01). For deceased donor recipients, RDP was associated with significantly better PS (P < 0.01), GS (P < 0.01) and DCGS (P < 0.01). There was no difference between groups in the rate of acute or chronic rejection, or in the mean estimated glomerular filtration rate at 15 years. However, RDP-treated recipients had significantly lower rates of avascular necrosis, cytomegalovirus, cataracts, new-onset diabetes after transplant, and cardiac complications. Importantly, for recipients with GS longer than 5 years, there was no difference between groups in subsequent actuarial PS, GS, and DCGS. Conclusions In summary, at 15 years postkidney transplant, RDP did not lead to decreased in PS or GS, or an increase in graft dysfunction but as associated with reduced complication rates.",
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T1 - Rapid Discontinuation of Prednisone in Kidney Transplant Recipients

T2 - 15-Year Outcomes from the University of Minnesota

AU - Serrano, Oscar

AU - Kandaswamy, Raja

AU - Gillingham, Kristen

AU - Chinnakotla, Srinath

AU - Dunn, Ty B

AU - Finger, Erik B

AU - Payne, William D

AU - Ibrahim, Hassan

AU - Kukla, Aleksandra

AU - Spong, Richard S

AU - Issa, Naim

AU - Pruett, Timothy L

AU - Matas, Arthur J

PY - 2017/10/1

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N2 - Background Short- A nd intermediate-term results have been reported after rapid discontinuation of prednisone (RDP) in kidney transplant recipients. Yet there has been residual concern about late graft failure in the absence of maintenance prednisone. Methods From October 1, 1999, through June 1, 2015, we performed a total of 1553 adult first and second kidney transplants-1021 with a living donor, 532 with a deceased donor-under our RDP protocol. We analyzed the 15-year actuarial overall patient survival (PS), graft survival (GS), death-censored GS (DCGS), and acute rejection-free survival (ARFS) rates for RDP compared with historical controls on maintenance prednisone. Results For living donor recipients, the actuarial 15-year PS rates were similar between groups. But RDP was associated with increased GS (P = 0.02) and DCGS (P = 0.01). For deceased donor recipients, RDP was associated with significantly better PS (P < 0.01), GS (P < 0.01) and DCGS (P < 0.01). There was no difference between groups in the rate of acute or chronic rejection, or in the mean estimated glomerular filtration rate at 15 years. However, RDP-treated recipients had significantly lower rates of avascular necrosis, cytomegalovirus, cataracts, new-onset diabetes after transplant, and cardiac complications. Importantly, for recipients with GS longer than 5 years, there was no difference between groups in subsequent actuarial PS, GS, and DCGS. Conclusions In summary, at 15 years postkidney transplant, RDP did not lead to decreased in PS or GS, or an increase in graft dysfunction but as associated with reduced complication rates.

AB - Background Short- A nd intermediate-term results have been reported after rapid discontinuation of prednisone (RDP) in kidney transplant recipients. Yet there has been residual concern about late graft failure in the absence of maintenance prednisone. Methods From October 1, 1999, through June 1, 2015, we performed a total of 1553 adult first and second kidney transplants-1021 with a living donor, 532 with a deceased donor-under our RDP protocol. We analyzed the 15-year actuarial overall patient survival (PS), graft survival (GS), death-censored GS (DCGS), and acute rejection-free survival (ARFS) rates for RDP compared with historical controls on maintenance prednisone. Results For living donor recipients, the actuarial 15-year PS rates were similar between groups. But RDP was associated with increased GS (P = 0.02) and DCGS (P = 0.01). For deceased donor recipients, RDP was associated with significantly better PS (P < 0.01), GS (P < 0.01) and DCGS (P < 0.01). There was no difference between groups in the rate of acute or chronic rejection, or in the mean estimated glomerular filtration rate at 15 years. However, RDP-treated recipients had significantly lower rates of avascular necrosis, cytomegalovirus, cataracts, new-onset diabetes after transplant, and cardiac complications. Importantly, for recipients with GS longer than 5 years, there was no difference between groups in subsequent actuarial PS, GS, and DCGS. Conclusions In summary, at 15 years postkidney transplant, RDP did not lead to decreased in PS or GS, or an increase in graft dysfunction but as associated with reduced complication rates.

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