Early Steroid Withdrawal Versus Steroid Maintenance in Adults Older than 65 Receiving Second Kidney Transplants

IF 0.8 4区医学 Q4 IMMUNOLOGY

Transplantation proceedings Pub Date : 2024-12-01 DOI:10.1016/j.transproceed.2024.10.037

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.

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65岁以上接受第二次肾移植的成人早期类固醇停药与类固醇维持

背景：由于排斥反应和不良事件风险之间的复杂平衡，类固醇维持（SM）治疗在老年人肾再移植中的作用尚不确定。我们的目的是评估他们的长期结果，比较SM和早期类固醇停药（ESW）。方法：回顾性联合器官共享登记队列研究。我们纳入了在2010年至2022年间接受单纯肾再移植、接受诱导并服用他克莫司出院的65岁以上成年人。我们使用多变量Cox比例风险模型，调整了几个供体、移植和受体协变量，评估了SM与ESW患者出院时的患者死亡率、全因同种异体移植失败和死亡审查移植失败（DCGF）。结果通过计算的面板反应性抗体（cPRA）进一步分层（80）。结果：我们纳入了1858例老年人再移植（61.3%为男性，年龄68岁[四分位数范围66 ~ 71]岁），随访2.98年（四分位数范围1.00 ~ 5.28]年）。大多数患者（77.9%）接受SM治疗，22.1%接受ESW治疗。ESW和SM在患者死亡（风险比[HR] 1.01, 95%可信区间[CI] 0.83 ~ 1.24）、全因同种异体移植失败（HR 0.95, 95% CI 0.78 ~ 1.16）和DCGF （HR 0.97, 95% CI 0.78 ~ 1.22）方面无统计学差异。在低cPRA亚组中，SM与患者死亡率增加相关（HR 1.45, 95% CI 1.01 ~ 2.08）。在高cPRA亚组中，SM与全因同种异体移植失败（HR 0.70, 95% CI 0.52 ~ 0.95）和DCGF （HR 0.66, 95% CI 0.47 ~ 0.93）降低相关。结论：类固醇维持治疗不会改变65岁以上再移植患者的长期预后。然而，SM在高cPRA亚组中可能是有益的，在低cPRA亚组中可能是有害的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Transplantation proceedings 医学-免疫学

CiteScore

1.70

自引率

0.00%

发文量

502

审稿时长

60 days

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.