ArticleJornal brasileiro de nefrologia
Effectiveness of steroid-free immunosuppressive regimens after kidney transplantation: the pioneering experience of a brazilian center.
Article in Jornal brasileiro de nefrologia. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionChronic corticosteroid use, even at low doses, is associated with well-known adverse effects. However, steroid-free regimens after kidney transplantation (KT) have been linked to a higher incidence of acute rejection (AR), limiting their implementation to a few centers worldwide. In this study, we describe the pioneering experience of a Brazilian center that adopted a steroid-free immunosuppressive regimen in 2005 for patients at low to moderate immunological risk.
methodsThis single-center retrospective cohort study includes KT recipients who were submitted to steroid-free regimens between 2012 and 2019. The cohort was followed for three years in a real-world setting.
resultsA total of 562 patients were included, 71.4% male, with a median age of 48.1 years (IQR 35.5-58.6). Most (95.2%) received deceased donor allografts. All patients underwent induction therapy with antithymocyte globulin, and 82.2% received tacrolimus in combination with sirolimus or everolimus as maintenance therapy. After three years, 10.2% experienced treated AR episodes, with biopsy confirmation in 3.2%. Age (HR 0.946, 95% CI 0.923-0.969, p < 0.001) and HLA mismatches (HR 1.312, 95% CI 1.021-1.687, p = 0.034) were risk factors for rejection. Twenty-eight patients (5%) lost their grafts, and 5.7% died. Seventy-one patients (12.6%) required corticosteroid introduction over the years, with a median of 125.5 days (IQR 31.7-409) post-KT. The main reasons were perceived immunosuppressive regimen inefficacy (56.3%) and composition in a low-efficacy immunosuppressive regimen (18.6%).
conclusionSteroid-free immunosuppression was effective in low to moderate immunological risk KT recipients over a three-year follow-up period.
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