J Andrade-Sierra1, E Rojas-Campos2, E Cardona-Muñoz3, L A Evangelista-Carrillo4, B Gómez-Navarro4, E González-Espinoza4, O Lugo-Lopez4, J I Cerrillos-Gutiérrez4, M Medina-Pérez4, B Jalomo-Martínez4, J J Nieves-Hernández4, M Sandoval4, J R Abundis-Jiménez4, J N Ramírez-Robles4, M A Villanueva-Pérez4, F Monteón-Ramos4, A M Cueto-Manzano2. 1. Medical Research Unit in Renal Diseases, Guadalajara, Jalisco, Mexico; Department of Nephrology and Organ Transplant Unit of the Specialties Hospital, Western National Medical Center, Mexican Social Security Institute (IMSS), Guadalajara, Jalisco, Mexico; Department of Physiology, Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Jalisco, Mexico. Electronic address: Jorg_Andrade@hotmail.com. 2. Medical Research Unit in Renal Diseases, Guadalajara, Jalisco, Mexico. 3. Department of Physiology, Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Jalisco, Mexico. 4. Department of Nephrology and Organ Transplant Unit of the Specialties Hospital, Western National Medical Center, Mexican Social Security Institute (IMSS), Guadalajara, Jalisco, Mexico.
Abstract
BACKGROUND:Early steroid withdrawal (ESW) can improve lipid and hemodynamic profiles without severe acute rejection (AR) events in renal transplant patients. Our objective was to evaluate the effects of ESW on the frequency and severity of AR. METHODS: A randomized, open-label, controlled clinical trial was performed on renal transplant recipients with a follow-up of 12 months. In the ESW group, patients were selected for corticosteroid treatment withdrawal on the fifth day post transplantation. In the Control group, patients continued with steroid treatment. All patients were over 18 years of age with panel reactive antibody (PRA) class I and II HLA <20%. RESULTS: In total, 71 patients, 37 in the ESW group (52.1%) and 34 in the Control group (47.9%), had comparable AR incidences at the end of the follow-up (16% vs 15%) (NS) (RR = 1.20, 95% CI = 0.32-3.33). Although renal graft survival was similar between the ESW and Control groups (87% vs 94%), renal function was superior in the ESW group (85 vs 75 mL/min). Additionally, hypertension was less frequent in the ESW group (3% vs 35%), requiring the use of fewer antihypertensives (8% vs 50%). CONCLUSIONS:ESW was also associated with better blood pressure control and similar AR risk. The ESW group exhibited stable renal function.
RCT Entities:
BACKGROUND: Early steroid withdrawal (ESW) can improve lipid and hemodynamic profiles without severe acute rejection (AR) events in renal transplant patients. Our objective was to evaluate the effects of ESW on the frequency and severity of AR. METHODS: A randomized, open-label, controlled clinical trial was performed on renal transplant recipients with a follow-up of 12 months. In the ESW group, patients were selected for corticosteroid treatment withdrawal on the fifth day post transplantation. In the Control group, patients continued with steroid treatment. All patients were over 18 years of age with panel reactive antibody (PRA) class I and II HLA <20%. RESULTS: In total, 71 patients, 37 in the ESW group (52.1%) and 34 in the Control group (47.9%), had comparable AR incidences at the end of the follow-up (16% vs 15%) (NS) (RR = 1.20, 95% CI = 0.32-3.33). Although renal graft survival was similar between the ESW and Control groups (87% vs 94%), renal function was superior in the ESW group (85 vs 75 mL/min). Additionally, hypertension was less frequent in the ESW group (3% vs 35%), requiring the use of fewer antihypertensives (8% vs 50%). CONCLUSIONS: ESW was also associated with better blood pressure control and similar AR risk. The ESW group exhibited stable renal function.
Authors: Jorge Andrade-Sierra; Alfonso M Cueto-Manzano; Enrique Rojas-Campos; Ernesto Cardona-Muñoz; José I Cerrillos-Gutiérrez; Eduardo González-Espinoza; Luis A Evangelista-Carrillo; Miguel Medina-Pérez; Basilio Jalomo-Martínez; Juan Nieves Hernández; Leonardo Pazarín-Villaseñor; Claudia A Mendoza-Cerpa; Benjamin Gómez-Navarro; Alejandra G Miranda-Díaz Journal: Int J Immunopathol Pharmacol Date: 2021 Jan-Dec Impact factor: 3.219