Clinical Relevance of Corticosteroid Withdrawal on Graft Histological Lesions in Low-Immunological-Risk Kidney Transplant Patients
Hernández, Domingo (Instituto de Investigación Biomédica de Málaga)
Alonso-Titos, Juana (Instituto de Investigación Biomédica de Málaga)
Vázquez, Teresa (Instituto de Investigación Biomédica de Málaga)
León, Myriam (Hospital Regional Universitario de Málaga)
Caballero, Abelardo (Instituto de Investigación Biomédica de Málaga)
Cobo, María Angeles (Hospital Universitario de Canarias (La Laguna))
Sola, Eugenia (Instituto de Investigación Biomédica de Málaga)
López Jiménez, Verónica (Instituto de Investigación Biomédica de Málaga)
Ruiz-Esteban, Pedro (Instituto de Investigación Biomédica de Málaga)
Cruzado, Josep María (Institut d'Investigació Biomèdica de Bellvitge)
Sellarés, Joana (Hospital Universitari Vall d'Hebron)
Moreso, Francesc (Hospital Universitari Vall d'Hebron)
Manonelles, Anna (Institut d'Investigació Biomèdica de Bellvitge)
Torío, Alberto (Instituto de Investigación Biomédica de Málaga)
Cabello, Mercedes (Instituto de Investigación Biomédica de Málaga)
Delgado-Burgos, Juan (Instituto de Investigación Biomédica de Málaga)
Casas, Cristina (Instituto de Investigación Biomédica de Málaga)
Gutiérrez, Elena (Instituto de Investigación Biomédica de Málaga)
Jironda, Cristina (Instituto de Investigación Biomédica de Málaga)
Kanter, Julia (Hospital Universitari Doctor Peset (València))
Seron, Daniel (Hospital Universitari Vall d'Hebron)
Torres, Armando (Hospital Universitario de Canarias (La Laguna))
Universitat Autònoma de Barcelona

Data:	2021
Resum:	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.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Subclinical inflammation ; Kidney transplant ; Protocol biopsy ; Corticosteroids withdrawal ; Low immunological risk ; Rejection ; Borderline lesions ; Chronic graft histological changes
Publicat a:	Journal of clinical medicine, Vol. 10 (may 2021) , ISSN 2077-0383

DOI: 10.3390/jcm10092005
PMID: 34067039

18 p, 1.0 MB

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