Twenty-Year Kidney Transplant Outcomes With Prednisone-Free Maintenance Immunosuppression: A Matched Control Analysis

There has been concern about long-term outcomes of kidney transplant recipients treated with prednisone-free maintenance immunosuppression. We studied 20-year outcomes for recipients treated with discontinuation of prednisone <1 week posttransplant (rapid discontinuation of prednisone [RDP]) compared with contemporaneous matched controls treated with maintenance prednisone (MP). First and second, adult living donor (LD) and deceased donor (DD) kidney transplant recipients from 1999 to 2009, treated with RDP were matched—using data from the Scientific Registry of Transplant Recipients—with contemporaneous controls, from large transplant centers, who were treated with MP. A total of 361 DD recipients treated with RDP were matched with 1805 treated with long-term MP. A total of 763 LD recipients treated with RDP were matched with 2289 treated with long-term MP. DD recipients treated with RDP had significantly better recipient survival (p = 0.02); there was no difference in graft or death-censored graft survival. For LD recipients, there was no difference between groups for all outcomes. Kidney transplant recipients treated with RDP had better or similar long-term outcomes as those treated with long-term MP. RDP should be considered for the majority of kidney transplant recipients.