TORONTO -- At the American Transplant Congress in Toronto last week, results were presented on the use of steroid-avoidance regimen in renal transplant recipients.
Richard Baker, MD, Renal Unit, St. James University Hospital, Leeds, United Kingdom, and colleagues analysed data on kidney transplant recipients treated with a steroid avoidance (January 2004 to October 2006) and a control group who received kidney transplants before the introduction of the steroid-avoidance regimen (2001 through 2003).
The study enrolled 258 low- to medium-risk adult patients who received kidney transplants treated with steroid avoidance and 216 patients who were not treated with steroid avoidance.
Baseline demographics were similar in the 2 groups except for higher proportions of "donation-after cardiac-death" (DCD) and living donors in the later cohort.
The researchers found that the rate of acute rejection was significantly higher in the steroid-avoidance group (19.8% vs 12.5%, P = .045). Furthermore, in those patients who experienced a rejection episode, the 1-year graft survival was significantly lower in the steroid avoidance group than in the control patients (80.3% vs 100% respectively, P = .045).
All the patients who remained on steroids after a rejection episode had a preserved graft at 1 year compared with 27.7% of the 36 patients who did not start steroid therapy after a rejection episode.
Based on these findings, Dr. Baker suggested that transplant physicians using steroid avoidance in their patients should look for early signs of rejection and reintroduce steroids if they notice any such signs.
"Any clinician looking after transplant patients who have steroid avoidance should be very vigilant for signs of rejection, and once detected, we would advocate continuing oral steroid treatment for at least 6 months," he said. "The question to address in the future is whether steroid-avoidance patients should undergo protocol biopsies to look for early subclinical rejection, and whether this deterioration in function can be rectified by continuing oral steroid therapy," Dr. Baker added.
