A propensity score matched analysis shows no adverse effect of early steroid withdrawal in non-diabetic kidney transplant recipients with and without glomerulonephritis

Kidney Int. 2019 Aug;96(2):460-469. doi: 10.1016/j.kint.2019.02.041. Epub 2019 Apr 1.

Abstract

Recurrent glomerulonephritis (GN) is a common cause of graft loss after kidney transplantation. Steroids are critical to GN management before transplantation, but it is unclear if early steroid withdrawal after transplantation increases the risk of graft loss in patients with GN. Here USRDS data were used to examine the association of early steroid withdrawal with death censored graft loss and all cause graft loss in GN and non-GN adult, non-diabetic, non-sensitized first kidney-only transplant recipients from 1998-2012. A 2-stage propensity score-based matching algorithm was used to match early steroid withdrawal to steroid-maintained patients in the GN and non-GN groups. Multivariate Cox models using a robust variance estimator to account for matched pairs were used to examine the association of early steroid withdrawal with death censored or all cause graft loss in patients with (6388 patients each in early steroid withdrawal and steroid groups) or without GN (6590 each in early steroid withdrawal and steroid groups). Early steroid withdrawal was not associated with an increased risk of death censored or all cause graft loss in patients with or without GN. These findings were consistent across GN types and after accounting for transplant center. Thus, our findings support consideration of early steroid withdrawal in patients with GN at high risk of the adverse consequences of prolonged steroid exposure.

Keywords: early steroid withdrawal; glomerulonephritis; graft survival; kidney transplantation.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Drug Administration Schedule
  • Female
  • Follow-Up Studies
  • Glomerulonephritis / drug therapy*
  • Glomerulonephritis / etiology
  • Glomerulonephritis / mortality
  • Glucocorticoids / administration & dosage*
  • Glucocorticoids / adverse effects
  • Graft Rejection / etiology
  • Graft Rejection / mortality
  • Graft Rejection / prevention & control*
  • Graft Survival
  • Humans
  • Immunosuppressive Agents / administration & dosage*
  • Immunosuppressive Agents / adverse effects
  • Kaplan-Meier Estimate
  • Kidney Failure, Chronic / mortality
  • Kidney Failure, Chronic / surgery*
  • Kidney Transplantation / adverse effects*
  • Male
  • Middle Aged
  • Postoperative Complications / etiology
  • Postoperative Complications / mortality
  • Postoperative Complications / prevention & control*
  • Propensity Score
  • Recurrence
  • Secondary Prevention / methods
  • Time Factors

Substances

  • Glucocorticoids
  • Immunosuppressive Agents

Grant support