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- Title
Clinical Relevance of Corticosteroid Withdrawal on Graft Histological Lesions in Low-Immunological-Risk Kidney Transplant Patients.
- Authors
Hernández, Domingo; Alonso-Titos, Juana; Vázquez, Teresa; León, Myriam; Caballero, Abelardo; Cobo, María Angeles; Sola, Eugenia; López, Verónica; Ruiz-Esteban, Pedro; Cruzado, Josep María; Sellarés, Joana; Moreso, Francesc; Manonelles, Anna; Torío, Alberto; Cabello, Mercedes; Delgado-Burgos, Juan; Casas, Cristina; Gutiérrez, Elena; Jironda, Cristina; Kanter, Julia
- Abstract
The impact of corticosteroid withdrawal on medium-term graft histological changes in kidney transplant (KT) recipients under standard immunosuppression is uncertain. As part of an open-label, multicenter, prospective, phase IV, 24-month clinical trial (ClinicalTrials.gov, NCT02284464) in low-immunological-risk KT recipients, 105 patients were randomized, after a protocol-biopsy at 3 months, to corticosteroid continuation (CSC, n = 52) or corticosteroid withdrawal (CSW, n = 53). Both groups received tacrolimus and MMF and had another protocol-biopsy at 24 months. The acute rejection rate, including subclinical inflammation (SCI), was comparable between groups (21.2 vs. 24.5%). No patients developed dnDSA. Inflammatory and chronicity scores increased from 3 to 24 months in patients with, at baseline, no inflammation (NI) or SCI, regardless of treatment. CSW patients with SCI at 3 months had a significantly increased chronicity score at 24 months. HbA1c levels were lower in CSW patients (6.4 ± 1.2 vs. 5.7 ± 0.6%; p = 0.013) at 24 months, as was systolic blood pressure (134.2 ± 14.9 vs. 125.7 ± 15.3 mmHg; p = 0.016). Allograft function was comparable between groups and no patients died or lost their graft. An increase in chronicity scores at 2-years post-transplantation was observed in low-immunological-risk KT recipients with initial NI or SCI, but CSW may accelerate chronicity changes, especially in patients with early SCI. This strategy did, however, improve the cardiovascular profiles of patients.
- Subjects
SPINAL cord injuries; KIDNEY transplantation; CORTICOSTEROIDS; SYSTOLIC blood pressure
- Publication
Journal of Clinical Medicine, 2021, Vol 10, Issue 9, p2005
- ISSN
2077-0383
- Publication type
Article
- DOI
10.3390/jcm10092005