Steroid free immunosuppression in renal transplantation: a single centre experience

D.S.Rana1, Dinesh Khullar1, Anurag Gupta1, Vinant Bhargava1, Kumar Digvijay1

Department of Nephrology, Sir Ganga Ram Hospital, New Delhi, India

BACKGROUND

Prolonged use of high dose corticosteroid is associated with considerable morbidity, including cardiovascular and metabolic adverse effects.

AIM/OBJECTIVES

To evaluate the long term safety and efficacy of steroid free immunosupression.

MATERIALS AND METHODS

Thirty seven out of 154 patients who had undergone renal transplantation surgery were randomly assigned to steroid free immunosuppression regimen. Patients were 23 male and 14 females, 19-65 years old with mean age of 43.10; all received living-related donor kidneys from the mean age of 44.2 years (0.62 years male, 0.37 years female) of the donor. HLA mismatches were 1/6 with mother, father, son, daughter, sister, 2/6 with cousin and 3/6 with wife and paired transplants.

Induction was given with Basiliximab, Daclizumab and Thymoglobulin. Maintenance immune suppression therapy used was Azathioprine+Tacrolimus, Mycophenolate mofetil+Tacrolimus.

All the 37 patients were randomly made steroid free after 15-60 days post transplantation Biopsy proven Antibody rejection was steroid responsive.

RESULTS

Thirty seven (24.02%) out of 154 patients who had undergone renal transplantation surgery were randomly assigned to steroid free immunosuppression regimen.

Male / n = 23 / Mean 0.62 years
Female / n =14 / Mean 0.37 years

Table no.1: Number of patients with Mean age

Mother / Father / Son / Daughter / Sister / Cousin / Wife / Paired Transplant
1/6 / 1/6 / 1/6 / 1/6 / 1/6 / 2/6 / 3/6 / 3/6

Table No. 2: HLA mismatches among the live related kidney transplants.

Three (8.10%) patients had type 2 diabetic mellitus. Basiliximab was used in 18 (48.64%) patients, daclizumab in 9(24.32%) patients, and Thymoglobulin was used in 10(27.02%) patients.

INDUCTION THERAPY / NO. OF PATIENTS
BAILIXIMAB / 18 (48.64%)
DACLIZUMAB / 9 (24.3%)
THYMOGLOBULIN / 10 (27.02%)

Table No. 3: Induction therapy used in transplantation

Maintenance immunosuppression therapy used was Azathioprine+Tacrolimus in 1 (2.7%) patient, Mycophenolate mofetil+Tacrolimus in 36(97.29%) patients.

MAINTENANCE IMMUNOSUPPRESSION / NO. OF PATIENTS
AZATHIOPRINE + TACROLIMUS / 1(2.7%)
MYCOPHENOLATE MOFETIL + TACROLIUMS / 36(97.29%)

Table No. 4: Maintenance Immunosuppression used

All the 37 patients were tapered off prednisolone during our study at different time intervals. Ten (27%) of the patients were on steroid free regimen after 15-30 days post transplant

Fig. Graph showing steroid withdrawn 15-30days post transplantation

Four (10.81%) of the patients were on steroid free after 30-45 days post transplant.

Fig. Graph showing steroid withdrawn 30-45days post transplantationl.

Twenty three (62.16%) of the patients were off steroid after 45-60 days post transplant.

Fig. Graph showing steroid withdrawn 45-60 days post transplantation.

The mean serum creatinine post transplantation surgery was 0.99 mg/dl at 15-30 days, 0.90 mg/dl at 30-45 days and 1.05 mg/dl at 45-60 days post tapering of steroid.

Out of the 37 patients, 2(5.4%) developed antibody mediated rejection which was steroid responsive. No patient developed NODAT amongst the 34 non diabetic mellitus patients.

COMCLUSION

This observational study shows that steroid withdrawal at 2 months post transplantation is safe. Although 2 patients developed antibody meditated rejection, both of them responded to the steroid therapy