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Late steroid withdrawal after ABO blood group-incompatible living donor kidney transplantation: high rate of mild cellular rejection


Oettl, T; Zuliani, E; Gaspert, A; Hopfer, H; Dickenmann, M; Fehr, T (2010). Late steroid withdrawal after ABO blood group-incompatible living donor kidney transplantation: high rate of mild cellular rejection. Transplantation, 89(6):702-706.

Abstract

BACKGROUND: Little is known about the safety of steroid withdrawal after ABO blood group-incompatible living donor kidney transplantation.

METHODS: Between September 2005 and November 2007, a total of 15 patients were successfully transplanted over the blood group barrier in our transplantation centers. Similarly to transplant recipients with normal immunological risk, we aimed to taper and eventually stop oral prednisone because of the well-known negative impact of steroids on cardiovascular morbidity and mortality, which in turn is limiting graft survival.

RESULTS: Up to now, patient and graft survival is 100% after a median follow-up of 839 days (range, 513-1281 days). On the basis of serial protocol biopsies, late steroid withdrawal could successfully be performed in only 5 of 11 patients. Nevertheless, the remaining 6 patients showed histologic signs of mild and subclinical acute rejection shortly after complete withdrawal or even during steroid tapering.

CONCLUSIONS: With this elevated risk of at least subclinical acute rejection after late steroid withdrawal, we propose that steroid withdrawal in ABO blood group-incompatible kidney graft recipients should only be performed after a protocol biopsy showing normal tissue and together with a thorough clinical and in doubtful cases also histologic follow-up.

BACKGROUND: Little is known about the safety of steroid withdrawal after ABO blood group-incompatible living donor kidney transplantation.

METHODS: Between September 2005 and November 2007, a total of 15 patients were successfully transplanted over the blood group barrier in our transplantation centers. Similarly to transplant recipients with normal immunological risk, we aimed to taper and eventually stop oral prednisone because of the well-known negative impact of steroids on cardiovascular morbidity and mortality, which in turn is limiting graft survival.

RESULTS: Up to now, patient and graft survival is 100% after a median follow-up of 839 days (range, 513-1281 days). On the basis of serial protocol biopsies, late steroid withdrawal could successfully be performed in only 5 of 11 patients. Nevertheless, the remaining 6 patients showed histologic signs of mild and subclinical acute rejection shortly after complete withdrawal or even during steroid tapering.

CONCLUSIONS: With this elevated risk of at least subclinical acute rejection after late steroid withdrawal, we propose that steroid withdrawal in ABO blood group-incompatible kidney graft recipients should only be performed after a protocol biopsy showing normal tissue and together with a thorough clinical and in doubtful cases also histologic follow-up.

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14 citations in Web of Science®
15 citations in Scopus®
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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Institute of Surgical Pathology
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:2010
Deposited On:20 Jan 2011 09:06
Last Modified:05 Apr 2016 14:37
Publisher:Lippincott Wiliams & Wilkins
ISSN:0041-1337
Publisher DOI:https://doi.org/10.1097/TP.0b013e3181c9cc67
PubMed ID:20010328
Permanent URL: https://doi.org/10.5167/uzh-42784

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