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Successful DCD kidney transplantation using early corticosteroid withdrawal
R E Chudzinski1, K Khwaja, P Teune
1Transplant Institute, Beth Israel Deaconess Medical Center, Boston, MA, USA. rchudzin@bidmc.harvard.edu
Summary
Early corticosteroid withdrawal (ECSW) in kidney transplantation from donors after cardiac death (DCD) shows comparable outcomes to long-term corticosteroid use. This approach offers similar graft survival and better death-censored graft survival in DCD kidney recipients.
Area of Science:
- Nephrology
- Transplantation Immunology
- Organ Donation
Background:
- Donors after cardiac death (DCD) are increasingly important for kidney transplantation.
- Traditional DCD kidney transplant protocols utilize prednisone-based immunosuppression.
- The safety and efficacy of early corticosteroid withdrawal (ECSW) in DCD kidney transplantation remain under investigation.
Purpose of the Study:
- To evaluate the outcomes of DCD kidney transplantation with early corticosteroid withdrawal (ECSW) compared to long-term corticosteroid therapy (LTCS).
- To assess the impact of ECSW on delayed graft function (DGF), acute rejection, and graft survival.
Main Methods:
- Retrospective analysis of 63 DCD kidney transplants performed between 2002 and 2007.
- Comparison of outcomes between 35 recipients undergoing ECSW and 28 recipients on LTCS.
- Assessment of DGF, serum creatinine, estimated GFR, acute rejection, graft survival, and death-censored graft survival.
Main Results:
- No significant differences in DGF rates (49% ECSW vs. 46% LTCS) or renal function between groups.
- Similar acute rejection rates at 1 year (11.4% ECSW vs. 21.4% LTCS).
- Comparable 1- and 3-year graft survival, with significantly better death-censored graft survival in the ECSW group (p=0.02).
Conclusions:
- Early corticosteroid withdrawal (ECSW) is a viable strategy in DCD kidney transplantation.
- ECSW demonstrates comparable or improved outcomes regarding DGF, rejection, and graft survival compared to LTCS.
- Multivariate analysis confirmed no negative correlation between corticosteroid use and survival outcomes in this DCD cohort.
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