Twenty-Year Kidney Transplant Outcomes With Prednisone-Free Maintenance Immunosuppression: A Matched Control Analysis

Area of Science:

• Nephrology
• Immunosuppression Therapy
• Transplant Medicine

Background:

• Concerns exist regarding long-term outcomes for kidney transplant recipients on prednisone-free immunosuppression.
• Prednisone maintenance therapy (MP) is a common immunosuppressive strategy post-kidney transplant.
• Rapid discontinuation of prednisone (RDP) aims to mitigate potential long-term side effects of prednisone.

Purpose of the Study:

• To compare 20-year outcomes of kidney transplant recipients undergoing RDP versus MP.
• To evaluate the impact of RDP on recipient survival, graft survival, and death-censored graft survival.
• To assess outcomes separately for living donor (LD) and deceased donor (DD) kidney transplants.

Main Methods:

• Retrospective cohort study matching RDP recipients with MP controls using the Scientific Registry of Transplant Recipients.
• Analysis included adult LD and DD kidney transplant recipients from 1999 to 2009.
• Matched cohorts: 361 DD (RDP) vs. 1805 (MP); 763 LD (RDP) vs. 2289 (MP).

Main Results:

• DD recipients on RDP demonstrated significantly better recipient survival compared to MP (p = 0.02).
• No significant differences in graft survival or death-censored graft survival were observed for DD recipients.
• For LD recipients, all measured outcomes (recipient survival, graft survival, death-censored graft survival) showed no significant differences between RDP and MP groups.

Conclusions:

• Kidney transplant recipients treated with RDP exhibit comparable or improved long-term outcomes compared to those on long-term MP.
• RDP is a safe and effective immunosuppression strategy that should be considered for most kidney transplant recipients.
• The findings support the wider adoption of RDP to potentially enhance long-term patient well-being post-transplant.