Clinic for Transplantation Immunology & Nephrology, University Hospital, Basel, Switzerland.
Transplantation. 2010 Mar 27;89(6):702-6. doi: 10.1097/TP.0b013e3181c9cc67.
Little is known about the safety of steroid withdrawal after ABO blood group-incompatible living donor kidney transplantation.
Between September 2005 and November 2007, a total of 15 patients were successfully transplanted over the blood group barrier in our transplantation centers. Similarly to transplant recipients with normal immunological risk, we aimed to taper and eventually stop oral prednisone because of the well-known negative impact of steroids on cardiovascular morbidity and mortality, which in turn is limiting graft survival.
Up to now, patient and graft survival is 100% after a median follow-up of 839 days (range, 513-1281 days). On the basis of serial protocol biopsies, late steroid withdrawal could successfully be performed in only 5 of 11 patients. Nevertheless, the remaining 6 patients showed histologic signs of mild and subclinical acute rejection shortly after complete withdrawal or even during steroid tapering.
With this elevated risk of at least subclinical acute rejection after late steroid withdrawal, we propose that steroid withdrawal in ABO blood group-incompatible kidney graft recipients should only be performed after a protocol biopsy showing normal tissue and together with a thorough clinical and in doubtful cases also histologic follow-up.
关于 ABO 血型不相容活体供肾移植后类固醇停药的安全性知之甚少。
2005 年 9 月至 2007 年 11 月，我们的移植中心共成功完成了 15 例 ABO 血型屏障移植。与免疫风险正常的移植受者一样，由于类固醇对心血管发病率和死亡率的负面影响众所周知，我们旨在逐渐减少并最终停止口服泼尼松，这反过来又限制了移植物的存活，因此我们也希望减少并最终停止口服泼尼松。
中位随访 839 天（513-1281 天）后，患者和移植物的存活率为 100%。根据系列方案活检，仅 11 例患者中的 5 例成功进行了晚期类固醇停药。然而，其余 6 例患者在完全停药或类固醇减量期间出现了轻度和亚临床急性排斥的组织学迹象。
鉴于晚期类固醇停药后至少亚临床急性排斥的风险增加，我们建议，ABO 血型不相容肾移植受者的类固醇停药仅应在方案活检显示正常组织后进行，同时进行彻底的临床检查，在有疑问的情况下还应进行组织学检查。
