Steroid Use in ABO-Incompatible Kidney Transplants: Withdrawal vs Maintenance

BACKGROUND The incidence of ABO-incompatible (ABO-i) kidney transplantation (KT) is increasing. Furthermore, it has a higher early mortality rate than ABO-compatible (ABO-c) KT, which is largely attributed to the extensive use of immunosuppressive agents. While steroid use in patients with ABO-c KT is being reduced, this effort is less prevalent in patients with ABO-i KT. Therefore, our study investigated the specific impact of steroid withdrawal on graft survival in patients with ABO-i KT. MATERIAL AND METHODS This study evaluated 33 patients who underwent ABO-i KT. The primary outcome was biopsy-proven acute rejection. The secondary outcomes were graft function, infection, new-onset diabetes mellitus after transplantation (NODAT), and delayed graft function. RESULTS In an average follow-up period of 57.0±23.7 months, the cumulative probabilities of biopsy-proven rejection at 3 years post-transplantation were 30.8% in the steroid maintenance group and 40.0% in the steroid withdrawal group, with no significant difference (hazard ratio, 1.11; 95% confidence interval 0.32-3.9; P=0.648). Graft function was similar between the 2 groups. Steroid withdrawal did not affect the rates of infection, NODAT, osteoporosis, cardiovascular disease, BK virus viremia, or cytomegalovirus viremia. CONCLUSIONS Steroid withdrawal did not differ from steroid maintenance in the rate of rejection or graft function due to any cause.