Department of Surgery, Division of Transplantation, University of Minnesota, Minneapolis, 55455, USA.
Clin J Am Soc Nephrol. 2012 Mar;7(3):494-503. doi: 10.2215/CJN.08630811. Epub 2012 Jan 26.
Rapid discontinuation of prednisone after kidney transplantation potentially allows for minimization of steroid-related side effects. Although intermediate-term data with rapid discontinuation of prednisone have been promising, concern still exists regarding long-term outcomes. The 10-year experience is reported herein.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Between October 1, 1999 and December 31, 2010, 1241 adult primary kidney transplants (791 living donor and 450 deceased donor) were performed using a protocol in which prednisone is discontinued after postoperative day 5. The 10-year actuarial recipient and graft survival rates and prednisone-related side effects were studied.
Ten-year actuarial patient survival was 71% for living donor transplants and 62% for deceased donor transplants; 10-year graft survival was 61% for living donor transplants and 51% for deceased donor transplants, and was comparable to 10-year Scientific Registry of Transplant Recipients national data. Ten-year death-censored graft survival was 79% for living donor transplants and 80% for deceased donor transplants. Ten-year acute rejection rates were 25% for deceased donor transplants and 31% for living donor transplants; 10-year chronic rejection (interstitial fibrosis/tubular atrophy) rates were 39% for deceased donor transplants and 47% for living donor transplants. For nondiabetic recipients of living donor or deceased donor allografts, the incidence of new-onset diabetes was significantly lower than in historical controls on prednisone (P<0.001). We also found significantly reduced rates of cataracts, avascular necrosis, and cytomegalovirus infection in some subgroups.
Prednisone-related side effects can be minimized in a protocol incorporating rapid discontinuation of prednisone for maintenance immunosuppression. Ten-year patient and graft outcomes remain acceptable.
肾移植后迅速停用泼尼松可最大限度减少类固醇相关副作用。尽管快速停用泼尼松的中期数据令人鼓舞，但对长期结果仍存在担忧。本研究报告了 10 年的经验。
设计、地点、参与者和测量：1999 年 10 月 1 日至 2010 年 12 月 31 日期间，采用术后第 5 天停用泼尼松的方案进行了 1241 例成人原发性肾移植（791 例活体供肾和 450 例尸肾）。研究了 10 年的受者和移植物存活率及泼尼松相关副作用。
10 年的受者存活率为活体供肾移植 71%，尸肾移植 62%；10 年的移植物存活率为活体供肾移植 61%，尸肾移植 51%，与 10 年的科学注册器官移植受者国家数据相当。10 年死亡相关移植物存活率为活体供肾移植 79%，尸肾移植 80%。10 年急性排斥反应率为尸肾移植 25%，活体供肾移植 31%；10 年慢性排斥反应（间质纤维化/肾小管萎缩）率为尸肾移植 39%，活体供肾移植 47%。对于活体供肾或尸肾同种异体移植物的非糖尿病受者，新发糖尿病的发生率明显低于泼尼松历史对照（P<0.001）。我们还发现，在某些亚组中，白内障、骨坏死和巨细胞病毒感染的发生率显著降低。
在维持免疫抑制的方案中，快速停用泼尼松可减少与泼尼松相关的副作用。10 年的患者和移植物结局仍然可以接受。
