Evaluation of renal transplantation recipients those who do not use steroid with panel reactive antibody and donor specific antibody
Abstract
Background: Steroids are the mainstream drugs of immunosuppressive regimen in renal transplantation. They are successfully used on induction, maintenance and rejection treatment. Due to complications caused by steroids, treatments are switched to immunosuppressive agents. Graft dysfunction risk caused by reduced total immunosuppression disturbs clinicians very often. We documented the differences among patients by means of clinical presentation and PRA/DSA levels between patients who are using steroids and patients that were prescribed for steroid-free regimen. Methods: 82 individuals who did not use steroid and 52 patients on steroid treatment were included with similar rates of age, sex, primary renal disease, dialysis type, posttransplant follow-up duration and donor type. Pre and posttransplant PRA, DSA levels, posttransplant and current graft function and comorbidities were evaluated. Results: Individuals who do not use steroids were found to have a lower posttransplant creatinine level and glomerular filtration rate (GFR) compared to steroid users. Posttransplant and current spot urinary protein/creatinine rates were also lower in the steroid-free group. However DM, BKVN and induction therapy rates were higher in the steroid-free group. PRA and DSA levels were similar in both groups. On the other hand, posttransplant PRA-I levels were significantly higher in those with less steroid use time. Conclusions: Although steroid free regimens usually worry the clinicians, they can be preferred in patients with low immunological risk for rejection to avoid its side effects such as uncontrolled diabetes, obesity, musculoskeletal problems and cataracts.
References
2) Pascual J, Quereda C, Zamora J, Hernández D; Spanish Group for Evidence-Based Medicine in Renal Transplantation. Steroid withdrawal in renal transplant patients on triple therapy with a calcineurin inhibitor and mycophenolate mofetil: a meta-analysis of randomized, controlled trials. Transplantation. 2004;78(10):1548-56. doi: 10.1097/01.tp.0000140969.43761.1f.
3) Rostaing L, Cantarovich D, Mourad G, Budde K, Rigotti P, Mariat C, et al.; CARMEN Study Group. Corticosteroid-free immunosuppression with tacrolimus, mycophenolate mofetil, and daclizumab induction in renal transplantation. Transplantation. 2005;79(7):807-14. doi: 10.1097/01.tp.0000154915.20524.0a.
4) Woodle ES, First MR, Pirsch J, Shihab F, Gaber AO, Van Veldhuisen P; Astellas Corticosteroid Withdrawal Study Group. A prospective, randomized, double-blind, placebo-controlled multicenter trial comparing early (7 day) corticosteroid cessation versus long-term, low-dose corticosteroid therapy. Ann Surg. 2008;248(4):564-77. doi: 10.1097/SLA.0b013e318187d1da.
5) Vincenti F, Schena FP, Paraskevas S, Hauser IA, Walker RG, Grinyo J; FREEDOM Study Group. A randomized, multicenter study of steroid avoidance, early steroid withdrawal or standard steroid therapy in kidney transplant recipients. Am J Transplant. 2008;8(2):307-16. doi: 10.1111/j.1600-6143.2007.02057.x.
6) Luan FL, Steffick DE, Ojo AO. Steroid-free maintenance immunosuppression in kidney transplantation: is it time to consider it as a standard therapy? Kidney Int. 2009;76(8):825-30. doi: 10.1038/ki.2009.248.
7) Steiner RW. Steroid-free chronic immunosuppression in renal transplantation. Curr Opin Nephrol Hypertens. 2012;21(6):567-73. doi: 10.1097/MNH.0b013e328359226c.
8) Haller MC, Royuela A, Nagler EV, Pascual J, Webster AC. Steroid avoidance or withdrawal for kidney transplant recipients. Cochrane Database Syst Rev. 2016;2016(8):CD005632. doi: 10.1002/14651858.CD005632.pub3.
9) Colvin RB. Antibody-mediated renal allograft rejection: diagnosis and pathogenesis. J Am Soc Nephrol. 2007;18(4):1046-56. doi: 10.1681/ASN.2007010073.
10) Worthington JE, Martin S, Al-Husseini DM, Dyer PA, Johnson RW. Posttransplantation production of donor HLA-specific antibodies as a predictor of renal transplant outcome. Transplantation. 2003;75(7):1034-40. doi: 10.1097/01.TP.0000055833.65192.3B.
11) Mao Q, Terasaki PI, Cai J, Briley K, Catrou P, Haisch C, et al. Extremely high association between appearance of HLA antibodies and failure of kidney grafts in a five-year longitudinal study. Am J Transplant. 2007;7(4):864-71. doi: 10.1111/j.1600-6143.2006.01711.x.
12) Lachmann N, Terasaki PI, Budde K, Liefeldt L, Kahl A, Reinke P, et al. Anti-human leukocyte antigen and donor-specific antibodies detected by luminex posttransplant serve as biomarkers for chronic rejection of renal allografts. Transplantation. 2009;87(10):1505-13. doi: 10.1097/TP.0b013e3181a44206.
13) Loupy A, Hill GS, Jordan SC. The impact of donor-specific anti-HLA antibodies on late kidney allograft failure. Nat Rev Nephrol. 2012;8(6):348-57. doi: 10.1038/nrneph.2012.81.
14) Tait BD, Süsal C, Gebel HM, Nickerson PW, Zachary AA, Claas FH, et al. Consensus guidelines on the testing and clinical management issues associated with HLA and non-HLA antibodies in transplantation. Transplantation. 2013;95(1):19-47. doi: 10.1097/TP.0b013e31827a19cc.
15) Luan FL, Steffick DE, Ojo AO. New-onset diabetes mellitus in kidney transplant recipients discharged on steroid-free immunosuppression. Transplantation. 2011;91(3):334-41. doi: 10.1097/TP.0b013e318203c25f.
16) Pathak V, Madhavan D, Narayanasamy K, Kumar S, Ramalingam V, Sengodagounder B, et al. Low-dose rituximab and thymoglobulin induction with steroid-free maintenance immunosuppression and protocol biopsies improves long-term patient and graft survival after kidney transplantation: survival and safety outcomes in more than 1100 patients from a single center. Transplant Direct. 2019;5(8):e475. doi: 10.1097/TXD.0000000000000923.
17) Sureshkumar KK, Marcus RJ, Chopra B. Role of steroid maintenance in sensitized kidney transplant recipients. World J Transplant. 2015;5(3):102-9. doi: 10.5500/wjt.v5.i3.102.
18) Cozzi E, Biancone L. C1q-binding donor-specific antibody assays help define risk and prognosis in antibody-mediated rejection. Kidney Int. 2018;94(4):657-9. doi: 10.1016/j.kint.2018.06.032.
19) Ponsirenas RVG, Cazarote HB, Araújo SA, Wanderley DC, Shimakura S, Valdameri JS, et al. Anti-HLA donor-specific IgG subclasses and C1q-binding evolution in posttransplant monitoring. Transplant Direct. 2018;4(9):e385. doi: 10.1097/TXD.0000000000000823.
20) da Silva CK, Meinerz G, Bruno RM, Abud J, Montagner J, Dorsdt DMB, et al. Late impact of preformed anti-HLA antibodies on kidney graft outcome. Transpl Immunol. 2019;55:101212. doi: 10.1016/j.trim.2019.06.004.
21) Thongprayoon C, Hansrivijit P, Leeaphorn N, Acharya P, Torres-Ortiz A, Kaewput W, et al. Recent advances and clinical outcomes of kidney transplantation. J Clin Med. 2020;9(4):1193. doi: 10.3390/jcm9041193.
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