The success of continued steroid avoidance after kidney transplantation in the US

Am J Transplant. 2009 Dec;9(12):2768-76. doi: 10.1111/j.1600-6143.2009.02838.x. Epub 2009 Oct 21.


There has been a significant increase in the use of steroid avoidance regimens as initial treatment for kidney transplant recipients. Early results of the effectiveness of this strategy has been mixed with certain prospective trials indicating increased acute rejection but population-based studies indicating similar or better graft survival as compared to steroid maintenance. We conducted a retrospective study of national registry data to evaluate risk factors for discontinuation of steroid avoidance protocols based on patient characteristics and concomitant immunosuppression. We evaluated 84 647 solitary kidney transplant recipients in the US with at least 6 months graft survival including 24 218 initially discharged without maintenance steroids. We utilized logistic models to assess risk factors for new initiation of steroids after initial steroid-avoidance and survival models to describe graft survival for patients after return to steroids. The most prominent risk factors for new initiation of steroids after deceased donor kidney transplantation included African-American race (AOR = 1.32, p < 0.01), retransplants (AOR = 1.81, p < 0.01), highly sensitized recipients (AOR = 1.29, p < 0.01), recipients with Medicaid (AOR = 1.85, p < 0.01), elevated HLA-MM (AOR = 1.26, p < 0.01) and older donor age (AOR = 1.19, p < 0.01). Concomitant medications were also significantly associated with the propensity to newly initiate steroids. Cumulatively the study suggests that both patient characteristics and concomitant medications are strongly associated with the success of steroid avoidance immunosuppressive regimens.

MeSH terms

  • Cadaver
  • Female
  • Graft Rejection / drug therapy
  • Graft Survival*
  • Humans
  • Immunosuppressive Agents / adverse effects*
  • Kidney Transplantation / adverse effects*
  • Kidney Transplantation / mortality
  • Living Donors
  • Male
  • Retrospective Studies
  • Risk Factors
  • Steroids / adverse effects*
  • Tissue Donors
  • Treatment Outcome
  • United States / epidemiology


  • Immunosuppressive Agents
  • Steroids