Rapid steroid withdrawal in hepatitis C virus positive kidney transplant recipients

UVA P; DE BOCCARDO G; BROMBERG J; AMES S; SEHGAL V; MURPHY B; SCHROPPEL B; AKALIN E

Boston

Congreso; World Transplant Congress; 2006

American Society of Transplantation

Hepatitis C Virus (HCV) + kidney transplant recipients are at higher risk of developing posttransplant diabetes mellitus (DM) and liver function test abnormalities due to immunosuppressive medications. We have recently reported the effects of rapid steroid withdrawal (RSW) in 12 HCV+ patients compared to 17 HCV+ patients, who were treated with a standard prednisone taper protocol, in a prospective cohort study at a median follow-up of 24 months. We now report the results of 47 HCV + patients, where 26 received RSW and 21 standard prednisone taper. Both groups were similar in terms of age, gender, race, type of donor, donor HCV status, pretransplant panel reactive antibody titers, pretransplant DM and hypertension (HTN), pretransplant liver biopsy stages and viral load. The RSW group received induction treatment (25 Thymoglobulin and 1 Basiliximab) with a calcineurin inhibitor (18 tacrolimus, 7 microemulsion cyclosporine, 1 rapamycin) and mycophenolate mofetil. During a median follow-up of 35 months (range, 5-51) in RSW group and 40 months (range, 5-60) in the control group, patient survival was 96.2% and 85.7%, graft survival 84.6% and 66.7%, respectively (p=NS). One RSW patient died due to infection and 3 patients in the control group due to infection (2) and myocardial infarction (1). Three RSW patients (2 Polyoma nephropathy and 1 acute humoral rejection) and 4 control patients (2 chronic allograft nephropathy, 1 acute humoral rejection and 1 donor disease) lost their allografts. Acute rejection (AR) episodes were 15.4% and 14.3%, and posttransplant liver function tests abnormalities were 7.7% and 19% in RSW and controls respectively (p=NS). 42.3% of the RSW group and 66.7% of the controls developed posttransplant HTN and 9.5% of the RSW group and 11.5% of the controls developed posttransplant DM  PTMD)(p=NS). Cardiovascular events of any type developed in 23.8 % of the RSW group and 26.9 % of controls. The mean creatinine was 1.73± 2.5 mg/dl in RSW and 1.56 ± 1.4mg/dl in controls. These results indicate that RSW is safe in HCV + patients without  ncreasing AR episodes. RSW patients demonstrated a trend for a better patient and graft survival, and less hypertension and liver function test abnormalities, although these differences were not statistically significant, probably due to a small number of the patients.