PMID- 26707301
OWN - NLM
STAT- MEDLINE
DCOM- 20160803
LR  - 20181202
IS  - 1873-2623 (Electronic)
IS  - 0041-1345 (Linking)
VI  - 47
IP  - 10
DP  - 2015 Dec
TI  - Human Leukocyte Antigen Mismatch and Steroid Maintenance in Kidney 
      Transplantation.
PG  - 2852-4
LID - S0041-1345(15)01020-9 [pii]
LID - 10.1016/j.transproceed.2015.10.028 [doi]
AB  - BACKGROUND: This study aimed to analyze the impact of chronic steroid maintenance 
      (CSM) vs early steroid withdrawal (ESW) in kidney transplant recipients (KTRs) 
      stratified by the level of human leukocyte antigen (HLA) mismatch. METHODS: Adult 
      KTRs between 2001 and 2011 who received antibody induction followed by 
      calcineurin inhibitor (CNI)/mycophenolate mofetil (MMF) maintenance with or 
      without steroid were identified from the Organ Procurement and Transplantation 
      Network/United Network for Organ Sharing (OPTN/UNOS) database. Using multivariate 
      analysis, graft and patient outcomes were compared for CSM vs ESW in KTRs 
      stratified by HLA mismatch levels separately for depleting and nondepleting 
      antibody-induced patients. RESULTS: Among 43,096 study patients, 26,582 received 
      depleting induction (zero HLA mismatch = 5324 [CSM = 3416; ESW = 1908]; 5-6 HLA 
      mismatch = 21,258 [CSM = 13,739; ESW = 7519]) and 16,514 patients received 
      nondepleting induction (zero HLA mismatch = 4109 [CSM = 3453; ESW = 656]; 5-6 HLA 
      mismatch = 12,405 [CSM = 10,890; ESW = 1515]). Adjusted graft failure risks for 
      CSM vs ESW groups for zero HLA mismatch patients were as follows: HR 1.13, P = 
      .07 (depleting induction); HR 1.30, P = .01 (nondepleting induction). Graft 
      outcomes were similar for CSM vs ESW in 5-6 HLA mismatch groups for both 
      induction types. Adjusted patient death risks were significantly higher for CSM 
      vs ESW with depleting (HR 1.3, P = .003) and nondepleting (HR 1.45, P = .006) 
      induction in zero HLA mismatch patients and only with depleting induction in 5-6 
      HLA mismatch groups (HR 1.16, P < .001). CONCLUSION: Our study supports the 
      feasibility of ESW regardless of the level of HLA mismatch in KTRs selected for 
      antibody induction and CNI/MMF maintenance.
CI  - Copyright (c) 2015 Elsevier Inc. All rights reserved.
FAU - Chopra, B
AU  - Chopra B
AD  - Division of Nephrology and Hypertension, Department of Medicine, Allegheny 
      General Hospital, Pittsburgh, Pennsylvania, United States.
FAU - Sureshkumar, K K
AU  - Sureshkumar KK
AD  - Division of Nephrology and Hypertension, Department of Medicine, Allegheny 
      General Hospital, Pittsburgh, Pennsylvania, United States. Electronic address: 
      ksureshk@wphas.org.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Transplant Proc
JT  - Transplantation proceedings
JID - 0243532
RN  - 0 (Calcineurin Inhibitors)
RN  - 0 (HLA Antigens)
RN  - 0 (Immunosuppressive Agents)
RN  - 0 (Steroids)
RN  - HU9DX48N0T (Mycophenolic Acid)
SB  - IM
MH  - Adult
MH  - Calcineurin Inhibitors/therapeutic use
MH  - Female
MH  - *HLA Antigens
MH  - Histocompatibility Testing
MH  - Humans
MH  - Immunosuppressive Agents/therapeutic use
MH  - *Kidney Transplantation
MH  - Maintenance Chemotherapy
MH  - Male
MH  - Mycophenolic Acid/analogs & derivatives/therapeutic use
MH  - Retrospective Studies
MH  - Steroids/*therapeutic use
MH  - Transplant Recipients
EDAT- 2015/12/29 06:00
MHDA- 2016/08/04 06:00
CRDT- 2015/12/29 06:00
PHST- 2015/08/11 00:00 [received]
PHST- 2015/09/25 00:00 [revised]
PHST- 2015/10/07 00:00 [accepted]
PHST- 2015/12/29 06:00 [entrez]
PHST- 2015/12/29 06:00 [pubmed]
PHST- 2016/08/04 06:00 [medline]
AID - S0041-1345(15)01020-9 [pii]
AID - 10.1016/j.transproceed.2015.10.028 [doi]
PST - ppublish
SO  - Transplant Proc. 2015 Dec;47(10):2852-4. doi: 10.1016/j.transproceed.2015.10.028.