Portal de Periódicos da CAPES

AFRICAN AMERICAN RENAL TRANSPLANT RECIPIENTS BENEFIT FROM EARLY CORTICOSTEROID WITHDRAWAL UNDER MODERN IMMUNOSUPPRESSION

2004; Wolters Kluwer; Volume: 78; Linguagem: Inglês

10.1097/00007890-200407271-00893

1534-6080

R Boardman, Rita R. Alloway, Wayne Alexander, Joseph F. Buell, Martina Cardi, Matthew R. First, Michael J. Hanaway, R Munda, Christin C. Rogers, Prabir Roy‐Chaudhury, B. Süßkind, J Trofe, E. Steve Woodle,

Organ Transplantation Techniques and Outcomes

P398 Aims: African Americans (AAs) have historically been considered high-risk renal transplant recipients due to increased rejection rates and reduced long-term graft survival. As a result, AAs are often excluded from corticosteroid withdrawal (CSWD) protocols. Modern immunosuppression (IS) has reduced rejections and improved graft survival in AAs and may allow successful CSWD. The purpose of the study was to determine if AAs could receive the benefits from early CSWD without an increase risk of rejection and graft loss. Methods: Outcomes in 56 AAs were compared to 56 non-AAs. All patients were enrolled in one of four early CSWD (<7 days) protocols. Patients were matched for age, gender, race, date of transplant and IS. Results: AAs had significantly more cadaveric donors (82% vs. 48%; P<0.01), HLA AB mismatches (2.8 vs. 2.2; P=0.02), and higher peak PRA (22% vs 10%; P=0.05). There was no difference in IS doses or levels for tacrolimus, cyclosporine, sirolimus, or mycophenolate exposure between groups. Thymoglobulin was administered to 46% of AAs vs. 61% non-AAs, P=NS. There was no difference in Thymoglobulin doses between groups. Length of follow-up is 427 ± 190 and 450 ± 221 for AAs and non-AAs. Patient and graft survival for AAs vs. non-AAs at last f/u was 96% vs. 98% and 91% vs. 91% (P=NS). The remaining results are presented in the table below:FigureAs benefited from early CSWD with significantly improved blood pressure, LDL 45 mg/dL at 1-year, an incidence of post-transplant diabetes of 8.7%, and mean weight change at 1-year of 4.8±7.2 kg. Conclusion: Early CSWD in AAs is associated with acceptable rejection rates despite having a higher incidence of risk factors for acute rejection, excellent patient and graft survival, and improved cardiovascular risk factors. Comparison of these results to non-AAs reveals that the risks and benefits of early CSWD in AAs are similar to non-AAs.