Ten-year outcome after rapid discontinuation of prednisone in adult primary kidney transplantation

Michael D. Rizzari, Thomas M. Suszynski, Kristen J. Gillingham, Ty B. Dunn, Hassan N. Ibrahim, William D. Payne, Srinath Chinnakotla, Erik B. Finger, David E R Sutherland, Raja Kandaswamy, John S. Najarian, Timothy L. Pruett, Aleksandra Kukla, Richard Spong, Arthur J. Matas

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Abstract

Background and objectives: Rapid discontinuation of prednisone after kidney transplantation potentially allows for minimization of steroid-related side effects. Although intermediate-term data with rapid discontinuation of prednisone have been promising, concern still exists regarding long-term outcomes. The 10-year experience is reported herein. Design, setting, participants, & measurements: Between October 1, 1999 and December 31, 2010, 1241 adult primary kidney transplants (791 living donor and 450 deceased donor)were performed using a protocol in which prednisone is discontinued after postoperative day 5. The 10-year actuarial recipient and graft survival rates and prednisone-related side effects were studied. Results: Ten-year actuarial patient survival was 71% for living donor transplants and 62% for deceased donor transplants; 10-year graft survivalwas 61%for living donor transplants and 51%for deceased donor transplants, and was comparable to 10-year Scientific Registry of Transplant Recipients national data. Ten-year deathcensored graft survival was 79% for living donor transplants and 80% for deceased donor transplants. Ten-year acute rejection rates were 25% for deceased donor transplants and 31% for living donor transplants; 10-year chronic rejection (interstitial fibrosis/tubular atrophy) rates were 39% for deceased donor transplants and 47% for living donor transplants. For nondiabetic recipients of living donor or deceased donor allografts, the incidence of new-onset diabetes was significantly lower than in historical controls on prednisone (P≤0.001).We also found significantly reduced rates of cataracts, avascular necrosis, and cytomegalovirus infection in some subgroups. Conclusions: Prednisone-related side effects can be minimized in a protocol incorporating rapid discontinuation of prednisone for maintenance immunosuppression. Ten-year patient and graft outcomes remain acceptable.

Original languageEnglish (US)
Pages (from-to)494-503
Number of pages10
JournalClinical Journal of the American Society of Nephrology
Volume7
Issue number3
DOIs
StatePublished - Mar 1 2012

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Prednisone
Living Donors
Kidney Transplantation
Transplants
Tissue Donors
Graft Survival
Cytomegalovirus Infections
Immunosuppression
Cataract
Atrophy
Allografts
Registries
Fibrosis
Necrosis
Survival Rate
Steroids
Maintenance
Kidney
Survival
Incidence

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Ten-year outcome after rapid discontinuation of prednisone in adult primary kidney transplantation. / Rizzari, Michael D.; Suszynski, Thomas M.; Gillingham, Kristen J.; Dunn, Ty B.; Ibrahim, Hassan N.; Payne, William D.; Chinnakotla, Srinath; Finger, Erik B.; Sutherland, David E R; Kandaswamy, Raja; Najarian, John S.; Pruett, Timothy L.; Kukla, Aleksandra; Spong, Richard; Matas, Arthur J.

In: Clinical Journal of the American Society of Nephrology, Vol. 7, No. 3, 01.03.2012, p. 494-503.

Research output: Contribution to journalArticle

Rizzari, Michael D. ; Suszynski, Thomas M. ; Gillingham, Kristen J. ; Dunn, Ty B. ; Ibrahim, Hassan N. ; Payne, William D. ; Chinnakotla, Srinath ; Finger, Erik B. ; Sutherland, David E R ; Kandaswamy, Raja ; Najarian, John S. ; Pruett, Timothy L. ; Kukla, Aleksandra ; Spong, Richard ; Matas, Arthur J. / Ten-year outcome after rapid discontinuation of prednisone in adult primary kidney transplantation. In: Clinical Journal of the American Society of Nephrology. 2012 ; Vol. 7, No. 3. pp. 494-503.
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AU - Ibrahim, Hassan N.

AU - Payne, William D.

AU - Chinnakotla, Srinath

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AU - Sutherland, David E R

AU - Kandaswamy, Raja

AU - Najarian, John S.

AU - Pruett, Timothy L.

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AU - Spong, Richard

AU - Matas, Arthur J.

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