PMID- 19295320
OWN - NLM
STAT- MEDLINE
DCOM- 20090522
LR  - 20211203
IS  - 1534-6080 (Electronic)
IS  - 0041-1337 (Linking)
VI  - 87
IP  - 5
DP  - 2009 Mar 15
TI  - Successful tapering of immunosuppression to low-dose monotherapy steroids after 
      living-related human leukocyte antigen-identical renal transplantation.
PG  - 740-4
LID - 10.1097/TP.0b013e31819634eb [doi]
AB  - BACKGROUND: Living-related (LR) human leukocyte antigen (HLA)-identical renal 
      transplant (RTx) recipients often receive standard immunosuppression, despite the 
      absence of mismatched major HLA-antigens and the known complications of long-term 
      use of immunosuppression. No data are available on the need for immunosuppression 
      for these specific patients. We wondered whether their immunosuppressive load 
      could be radically reduced. METHOD: Between November 1982 and November 2005, 83 
      LR HLA-identical RTx were performed in our center. Their unadjusted graft 
      survival was 74% at 10 years. In 29 patients (median time after transplantation 
      5.6 [range 1.0-21.4] years) with stable uncompromised renal function, we tapered 
      their immunosuppression from triple or dual therapy to prednisolone 5 mg/day. 
      Follow up on prednisolone monotherapy was at least 24 months. RESULTS: In 27 of 
      29 patients reduction of immunosuppression to prednisolone monotherapy was 
      uneventful. One patient, using dual therapy, developed JC-virus nephropathy 
      resulting in graft loss. One refused further discontinuation of his medication. 
      Four (15%) of the 27 patients on monotherapy developed biopsy-proven recurrence 
      of their original disease. Only one of them showed a transient decline in renal 
      function. One additional patient developed minor proteinuria and a rise in serum 
      creatinine level, as a result of chronic urinary tract infections. The remaining 
      23 of 27 patients (85%) had an uneventful follow up during 24 months prednisolone 
      monotherapy. CONCLUSION: We conclude that HLA-identical LR RTx recipients who are 
      at least 1 year after transplantation might be treated with low-dose steroid 
      monotherapy. Close surveillance of patients for recurrence of their original 
      disease is recommended to allow for potential early therapeutic intervention.
FAU - van de Wetering, Jacqueline
AU  - van de Wetering J
AD  - Department of Internal Medicine and Transplantation, Erasmus MC, University 
      Medical Center Rotterdam, Rotterdam, The Netherlands. 
      j.vandewetering.1@erasmusmc.nl
FAU - Gerrits, Jeroen H
AU  - Gerrits JH
FAU - van Besouw, Nicole M
AU  - van Besouw NM
FAU - Ijzermans, Jan N M
AU  - Ijzermans JN
FAU - Weimar, Willem
AU  - Weimar W
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Transplantation
JT  - Transplantation
JID - 0132144
RN  - 0 (Glucocorticoids)
RN  - 0 (HLA Antigens)
RN  - 9PHQ9Y1OLM (Prednisolone)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Drug Administration Schedule
MH  - *Family
MH  - Female
MH  - Glucocorticoids/therapeutic use
MH  - Graft Survival
MH  - HLA Antigens/*analysis
MH  - Humans
MH  - Immunosuppression Therapy/*methods
MH  - Kidney Diseases/classification/surgery
MH  - Kidney Transplantation/*immunology
MH  - *Living Donors
MH  - Male
MH  - Middle Aged
MH  - Prednisolone/*therapeutic use
MH  - Retrospective Studies
MH  - Survival Analysis
MH  - Young Adult
EDAT- 2009/03/20 09:00
MHDA- 2009/05/23 09:00
CRDT- 2009/03/20 09:00
PHST- 2009/03/20 09:00 [entrez]
PHST- 2009/03/20 09:00 [pubmed]
PHST- 2009/05/23 09:00 [medline]
AID - 00007890-200903150-00018 [pii]
AID - 10.1097/TP.0b013e31819634eb [doi]
PST - ppublish
SO  - Transplantation. 2009 Mar 15;87(5):740-4. doi: 10.1097/TP.0b013e31819634eb.