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Human Leukocyte Antigen Mismatch and Steroid Maintenance in Kidney Transplantation.
Transplant Proc 2015; 47(10):2852-4TP

Abstract

BACKGROUND

This study aimed to analyze the impact of chronic steroid maintenance (CSM) vs early steroid withdrawal (ESW) in kidney transplant recipients (KTRs) stratified by the level of human leukocyte antigen (HLA) mismatch.

METHODS

Adult KTRs between 2001 and 2011 who received antibody induction followed by calcineurin inhibitor (CNI)/mycophenolate mofetil (MMF) maintenance with or without steroid were identified from the Organ Procurement and Transplantation Network/United Network for Organ Sharing (OPTN/UNOS) database. Using multivariate analysis, graft and patient outcomes were compared for CSM vs ESW in KTRs stratified by HLA mismatch levels separately for depleting and nondepleting antibody-induced patients.

RESULTS

Among 43,096 study patients, 26,582 received depleting induction (zero HLA mismatch = 5324 [CSM = 3416; ESW = 1908]; 5-6 HLA mismatch = 21,258 [CSM = 13,739; ESW = 7519]) and 16,514 patients received nondepleting induction (zero HLA mismatch = 4109 [CSM = 3453; ESW = 656]; 5-6 HLA mismatch = 12,405 [CSM = 10,890; ESW = 1515]). Adjusted graft failure risks for CSM vs ESW groups for zero HLA mismatch patients were as follows: HR 1.13, P = .07 (depleting induction); HR 1.30, P = .01 (nondepleting induction). Graft outcomes were similar for CSM vs ESW in 5-6 HLA mismatch groups for both induction types. Adjusted patient death risks were significantly higher for CSM vs ESW with depleting (HR 1.3, P = .003) and nondepleting (HR 1.45, P = .006) induction in zero HLA mismatch patients and only with depleting induction in 5-6 HLA mismatch groups (HR 1.16, P < .001).

CONCLUSION

Our study supports the feasibility of ESW regardless of the level of HLA mismatch in KTRs selected for antibody induction and CNI/MMF maintenance.

Authors+Show Affiliations

Division of Nephrology and Hypertension, Department of Medicine, Allegheny General Hospital, Pittsburgh, Pennsylvania, United States.Division of Nephrology and Hypertension, Department of Medicine, Allegheny General Hospital, Pittsburgh, Pennsylvania, United States. Electronic address: ksureshk@wphas.org.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

26707301

Citation

Chopra, B, and K K. Sureshkumar. "Human Leukocyte Antigen Mismatch and Steroid Maintenance in Kidney Transplantation." Transplantation Proceedings, vol. 47, no. 10, 2015, pp. 2852-4.
Chopra B, Sureshkumar KK. Human Leukocyte Antigen Mismatch and Steroid Maintenance in Kidney Transplantation. Transplant Proc. 2015;47(10):2852-4.
Chopra, B., & Sureshkumar, K. K. (2015). Human Leukocyte Antigen Mismatch and Steroid Maintenance in Kidney Transplantation. Transplantation Proceedings, 47(10), pp. 2852-4. doi:10.1016/j.transproceed.2015.10.028.
Chopra B, Sureshkumar KK. Human Leukocyte Antigen Mismatch and Steroid Maintenance in Kidney Transplantation. Transplant Proc. 2015;47(10):2852-4. PubMed PMID: 26707301.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Human Leukocyte Antigen Mismatch and Steroid Maintenance in Kidney Transplantation. AU - Chopra,B, AU - Sureshkumar,K K, PY - 2015/08/11/received PY - 2015/09/25/revised PY - 2015/10/07/accepted PY - 2015/12/29/entrez PY - 2015/12/29/pubmed PY - 2016/8/4/medline SP - 2852 EP - 4 JF - Transplantation proceedings JO - Transplant. Proc. VL - 47 IS - 10 N2 - BACKGROUND: This study aimed to analyze the impact of chronic steroid maintenance (CSM) vs early steroid withdrawal (ESW) in kidney transplant recipients (KTRs) stratified by the level of human leukocyte antigen (HLA) mismatch. METHODS: Adult KTRs between 2001 and 2011 who received antibody induction followed by calcineurin inhibitor (CNI)/mycophenolate mofetil (MMF) maintenance with or without steroid were identified from the Organ Procurement and Transplantation Network/United Network for Organ Sharing (OPTN/UNOS) database. Using multivariate analysis, graft and patient outcomes were compared for CSM vs ESW in KTRs stratified by HLA mismatch levels separately for depleting and nondepleting antibody-induced patients. RESULTS: Among 43,096 study patients, 26,582 received depleting induction (zero HLA mismatch = 5324 [CSM = 3416; ESW = 1908]; 5-6 HLA mismatch = 21,258 [CSM = 13,739; ESW = 7519]) and 16,514 patients received nondepleting induction (zero HLA mismatch = 4109 [CSM = 3453; ESW = 656]; 5-6 HLA mismatch = 12,405 [CSM = 10,890; ESW = 1515]). Adjusted graft failure risks for CSM vs ESW groups for zero HLA mismatch patients were as follows: HR 1.13, P = .07 (depleting induction); HR 1.30, P = .01 (nondepleting induction). Graft outcomes were similar for CSM vs ESW in 5-6 HLA mismatch groups for both induction types. Adjusted patient death risks were significantly higher for CSM vs ESW with depleting (HR 1.3, P = .003) and nondepleting (HR 1.45, P = .006) induction in zero HLA mismatch patients and only with depleting induction in 5-6 HLA mismatch groups (HR 1.16, P < .001). CONCLUSION: Our study supports the feasibility of ESW regardless of the level of HLA mismatch in KTRs selected for antibody induction and CNI/MMF maintenance. SN - 1873-2623 UR - https://www.unboundmedicine.com/medline/citation/26707301/Human_Leukocyte_Antigen_Mismatch_and_Steroid_Maintenance_in_Kidney_Transplantation_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0041-1345(15)01020-9 DB - PRIME DP - Unbound Medicine ER -