RT Journal Article
T1 Clinical Relevance of Corticosteroid Withdrawal on Graft Histological Lesions in Low-Immunological-Risk Kidney Transplant Patients
A1 Hernández, Domingo
A1 Alonso-Titos, Juana
A1 Vázquez, Teresa
A1 León, Myriam
A1 Caballero, Abelardo
A1 Cobo, María Angeles
A1 Sola, Eugenia
A1 López, Verónica
A1 Ruiz-Esteban, Pedro
A1 Cruzado, Josep María
A1 Sellarés, Joana
A1 Moreso, Francesc
A1 Manonelles, Anna
A1 Torío, Alberto
A1 Cabello, Mercedes
A1 Delgado-Burgos, Juan
A1 Casas, Cristina
A1 Gutiérrez, Elena
A1 Jironda, Cristina
A1 Kanter, Julia
A1 Serón, Daniel
A1 Torres, Armando
K1 Subclinical inflammation
K1 Kidney transplant
K1 Protocol biopsy
K1 Corticosteroids withdrawal
K1 Low immunological risk
K1 Rejection
K1 Borderline lesions
K1 Chronic graft histological changes
AB The impact of corticosteroid withdrawal on medium-term graft histological changes in kidney transplant (KT) recipients under standard immunosuppression is uncertain. As part of an open-label, multicenter, prospective, phase IV, 24-month clinical trial (ClinicalTrials.gov, NCT02284464) in low-immunological-risk KT recipients, 105 patients were randomized, after a protocol-biopsy at 3 months, to corticosteroid continuation (CSC, n = 52) or corticosteroid withdrawal (CSW, n = 53). Both groups received tacrolimus and MMF and had another protocol-biopsy at 24 months. The acute rejection rate, including subclinical inflammation (SCI), was comparable between groups (21.2 vs. 24.5%). No patients developed dnDSA. Inflammatory and chronicity scores increased from 3 to 24 months in patients with, at baseline, no inflammation (NI) or SCI, regardless of treatment. CSW patients with SCI at 3 months had a significantly increased chronicity score at 24 months. HbA1c levels were lower in CSW patients (6.4 ± 1.2 vs. 5.7 ± 0.6%; p = 0.013) at 24 months, as was systolic blood pressure (134.2 ± 14.9 vs. 125.7 ± 15.3 mmHg; p = 0.016). Allograft function was comparable between groups and no patients died or lost their graft. An increase in chronicity scores at 2-years post-transplantation was observed in low-immunological-risk KT recipients with initial NI or SCI, but CSW may accelerate chronicity changes, especially in patients with early SCI. This strategy did, however, improve the cardiovascular profiles of patients.
PB MDPI
YR 2021
FD 2021-05-07
LK http://hdl.handle.net/10668/4055
UL http://hdl.handle.net/10668/4055
LA en
NO Hernández D, Alonso-Titos J, Vázquez T, León M, Caballero A, Cobo MA, et al. Clinical Relevance of Corticosteroid Withdrawal on Graft Histological Lesions in Low-Immunological-Risk Kidney Transplant Patients. J Clin Med. 2021 May 7;10(9):2005.
DS RISalud
RD Apr 7, 2025