Document Detail


Intermediate-term outcomes with early steroid withdrawal in African-American renal transplant recipients undergoing surveillance biopsy.
MedLine Citation:
PMID:  17950346     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: There is a paucity of data regarding the use of early corticosteroid withdrawal (ESW) in African-American renal allograft recipients, and very few reports with >or=1 year follow-up in all patients. METHODS: We examined the outcomes of 57 African-American renal allograft recipients with minimum follow-up 12 months who did not receive maintenance steroids after day 4 posttransplant. All patients received thymoglobulin induction, mycophenolate mofetil, and initial tacrolimus (n = 48) or sirolimus (n = 9). RESULTS: Patient and graft survival were 98% and 96% at 1 year, and 95% and 89% over the entire follow-up period (mean, 23 +/- 8 months). Incidence of acute rejection and cytomegalovirus infection were 18% and 7%, respectively, with mean serum creatinine 1.6 +/- 0.5 and 1.7 +/- 0.9 mg/dL at 6 and 12 months. Of patients with functioning grafts, 84% remained steroid free at 1 year, of which 11 (24%) were also calcineurin inhibitor free. Twenty-seven patients underwent surveillance biopsy at 1 month and 28 at 12 months, with 15 surveyed at both time points. There were significant increases in only 2 of the 6 1997 Banff chronic allograft nephropathy (CAN) category scores in this subgroup, with all mean values remaining <1 (mild in severity) at 1 year. Overall, from 82% to 96% of the 12-month scores were <or=1 in all categories for 28 patients; only 3 patients (11%) had interstitial fibrosis and tubular atrophy scores at least moderate in severity. We did not observe any cases of subclinical acute rejection. CONCLUSIONS: Our findings suggest that ESW in African-American renal allograft recipients with multiple high-risk factors can produce excellent intermediate-term antirejection and graft functional outcomes with minimal development of CAN at 12 months. Our results will need to be verified in larger numbers of patients with longer follow-up.
Authors:
Xu Zeng; Jose M El-Amm; Mona D Doshi; Atul Singh; Katherina Morawski; Elizabeth Cincotta; Julian E Losanoff; Miguel S West; Scott A Gruber
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Surgery     Volume:  142     ISSN:  0039-6060     ISO Abbreviation:  Surgery     Publication Date:  2007 Oct 
Date Detail:
Created Date:  2007-10-22     Completed Date:  2007-12-06     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0417347     Medline TA:  Surgery     Country:  United States    
Other Details:
Languages:  eng     Pagination:  538-44; discussion 544-5     Citation Subset:  AIM; IM    
Affiliation:
Department of Laboratory Medicine & Pathology, Wayne State University School of Medicine, Detroit, MI, USA.
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Adrenal Cortex Hormones / administration & dosage*
Adult
African Americans / statistics & numerical data*
Biopsy / statistics & numerical data
Follow-Up Studies
Graft Rejection / drug therapy*,  ethnology*
Graft Survival
Humans
Immunosuppression
Incidence
Kidney Transplantation / ethnology*,  statistics & numerical data*
Middle Aged
Retrospective Studies
Risk Factors
Transplantation, Homologous
Treatment Outcome
Chemical
Reg. No./Substance:
0/Adrenal Cortex Hormones

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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