Prednisone-free maintenance immunosuppression-a 5-year experience

Am J Transplant. 2005 Oct;5(10):2473-8. doi: 10.1111/j.1600-6143.2005.01051.x.

Abstract

Concern persists that prednisone-free maintenance immunosuppression in kidney transplant recipients will be associated with an increase in late allograft dysfunction and graft loss. We herein report 5-year follow-up of a trial of prednisone-free maintenance immunosuppression. From October 1, 1999, through January 31, 2005, at our center, 589 kidney transplant recipients were treated with a protocol incorporating discontinuation of their prednisone on postoperative day 6. At 5 years, actuarial patient survival was 91%; graft survival, 84%; death-censored graft survival, 92%; acute rejection-free graft survival, 84% and chronic rejection-free graft survival, 87%. The mean serum creatinine level (+/-SD) at 1 year was 1.6 +/- 0.6; at 5 years, 1.7 +/- 0.8. In all, 86% of kidney recipients with functioning grafts remain prednisone-free as of April 30, 2005. As compared with historical controls, recipients on prednisone-free maintenance immunosuppression had a significantly lower rate of a number of complications, including cataracts (p < 0.001), posttransplant diabetes mellitus (p < 0.001), avascular necrosis (p = 0.001), and fractures (p = 0.004). We conclude that prednisone-related side effects can be minimized in a protocol incorporating prednisone-free maintenance immunosuppression. Five-year graft outcome remains good.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Anti-Infective Agents / therapeutic use
  • Antifungal Agents / therapeutic use
  • Antiviral Agents / therapeutic use
  • Cataract / etiology
  • Clotrimazole / therapeutic use
  • Cohort Studies
  • Creatinine / blood
  • Dapsone / therapeutic use
  • Diabetes Mellitus / etiology
  • Fractures, Bone / etiology
  • Ganciclovir / analogs & derivatives
  • Ganciclovir / therapeutic use
  • Graft Rejection
  • Graft Survival
  • Humans
  • Immunosuppression
  • Immunosuppressive Agents / administration & dosage
  • Immunosuppressive Agents / therapeutic use*
  • Kidney Transplantation / methods*
  • Necrosis / etiology
  • Nystatin / therapeutic use
  • Pentamidine / therapeutic use
  • Prednisone / administration & dosage*
  • Time Factors
  • Transplantation, Homologous / methods
  • Treatment Outcome
  • Trimethoprim, Sulfamethoxazole Drug Combination / therapeutic use
  • Valganciclovir

Substances

  • Anti-Infective Agents
  • Antifungal Agents
  • Antiviral Agents
  • Immunosuppressive Agents
  • Nystatin
  • Pentamidine
  • Trimethoprim, Sulfamethoxazole Drug Combination
  • Dapsone
  • Creatinine
  • Clotrimazole
  • Valganciclovir
  • Ganciclovir
  • Prednisone