Late steroid withdrawal and cardiovascular events in kidney transplant recipients

Transplantation. 2008 Dec 27;86(12):1844-8. doi: 10.1097/TP.0b013e31818ffec0.

Abstract

Introduction: Cardiovascular events (CVE) are the leading cause of mortality in kidney transplant recipients. The adverse effects of long-term therapy with steroids on cardiovascular risk have motivated increasing interest in steroid withdrawal (SW). The objective of this study was to compare the incidences of CVE and all-cause mortality between patients who had undergone SW at 1 year posttransplant and control patients who continued on steroids.

Methods: A cohort of 400 consecutive adult recipients of a kidney transplant between 1993 and 1998 who qualified for late SW was studied. At 1 year posttransplant 188 patients underwent SW, whereas 212 patients continued on steroids. Cox proportional-hazards analysis was used to estimate CVE (cardiac and cerebrovascular events) and all-cause mortality hazard ratios (HR) for patients who had undergone SW versus controls who continued on steroids beyond 1 year.

Results: The average follow-up was 61 months. There were 44 (11%) cardiac events, 18 (4.5%) cerebrovascular events, and 41 deaths (10.3%). The composite outcome of CVE and all-cause mortality was reached in 26 (13.8%) subjects who had undergone SW and 50 (23.6%) controls (P=0.013). In adjusted analyses, SW was associated with decreased risk for the composite outcome (HR 0.46, 95% confidence interval [CI] 0.28-0.76), cardiac events (HR 0.48, 95% CI 0.28-0.84), and all-cause mortality (HR 0.27, 95% CI 0.12-0.59). There was no association of SW with the risk for cerebrovascular events (HR 1.76, 95% CI 0.45-7.01).

Conclusion: In this retrospective analysis, SW at 1 year posttransplant was associated with decreased risk for future CVE and all-cause mortality.

MeSH terms

  • Adrenal Cortex Hormones / adverse effects*
  • Adult
  • Cardiovascular Diseases / epidemiology*
  • Cardiovascular Diseases / etiology
  • Cardiovascular Diseases / mortality
  • Cerebrovascular Disorders / epidemiology
  • Cerebrovascular Disorders / mortality
  • Cohort Studies
  • Continental Population Groups
  • Drug Administration Schedule
  • Female
  • Heart Diseases / epidemiology
  • Heart Diseases / mortality
  • Humans
  • Kidney Transplantation / adverse effects*
  • Kidney Transplantation / physiology*
  • Male
  • Middle Aged
  • Proportional Hazards Models
  • Retrospective Studies
  • Survival Analysis
  • Time Factors

Substances

  • Adrenal Cortex Hormones