Stalin Cañizares , Gabriel Cojuc-Konigsberg , Belen Rivera , Aditya S. Pawar , Devin Eckhoff , Bhavna Chopra
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引用次数: 0
Abstract
Background
The role of steroid maintenance (SM) therapy in older adults with kidney retransplants is uncertain due to the intricate balance between rejection and adverse event risks. We aimed to assess their long-term outcomes, comparing SM versus early steroid withdrawal (ESW).
Methods
Retrospective United Network for Organ Sharing registry cohort study. We included adults older than 65 who underwent kidney-only retransplantation between 2010 and 2022, received induction and were discharged on tacrolimus. We evaluated patient death, all-cause allograft failure, and death-censored graft failure (DCGF) among individuals with SM vs ESW at discharge using multivariate Cox proportional hazards models adjusting for several donor, transplant, and recipient covariates. Outcomes were further stratified by calculated panel reactive antibody (cPRA) (<20, 20 to 80, >80).
Results
We included 1858 older adult retransplants (61.3% male, age 68 [interquartile ranges 66 to 71] years), follow-up 2.98 [interquartile ranges 1.00 to 5.28] years). Most (77.9%) received SM, whereas 22.1% had ESW. No statistically significant differences between ESW and SM were observed for patient death (hazard ratios [HR] 1.01, 95% confidence intervals [CI] 0.83 to 1.24), all-cause allograft failure (HR 0.95, 95% CI 0.78 to 1.16), and DCGF (HR 0.97, 95% CI 0.78 to 1.22). In the low cPRA subgroup, SM was associated with increased patient death (HR 1.45, 95% CI 1.01 to 2.08 In those with high cPRA, SM was associated with lower all-cause allograft failure (HR 0.70, 95% CI 0.52 to 0.95) and DCGF (HR 0.66, 95% CI 0.47 to 0.93).
Conclusion
Steroid-maintenance did not alter long-term outcomes in retransplants in adults older than 65. However, SM may be beneficial in high cPRA and harmful in low cPRA subgroups.
期刊介绍:
Transplantation Proceedings publishes several different categories of manuscripts, all of which undergo extensive peer review by recognized authorities in the field prior to their acceptance for publication.
The first type of manuscripts consists of sets of papers providing an in-depth expression of the current state of the art in various rapidly developing components of world transplantation biology and medicine. These manuscripts emanate from congresses of the affiliated transplantation societies, from Symposia sponsored by the Societies, as well as special Conferences and Workshops covering related topics.
Transplantation Proceedings also publishes several special sections including publication of Clinical Transplantation Proceedings, being rapid original contributions of preclinical and clinical experiences. These manuscripts undergo review by members of the Editorial Board.
Original basic or clinical science articles, clinical trials and case studies can be submitted to the journal?s open access companion title Transplantation Reports.