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Nephrol Dial Transplant (2000) 15: 1041-1045
© 2000 European Renal Association-European Dialysis and Transplant Association

Withdrawal of steroids from triple-drug therapy in kidney transplant patients

Ivo Matl1,, Jirí Lácha1, Alena Lodererová2, Marcela Símová1, Vladimír Teplan1, Vera Lánská3 and Stefan Vítko4

1 Department of Nephrology, 2 Department of Pathology, 3 Department of Statistics and 4 Transplant Center, Institute for Clinical and Experimental Medicine, Prague, Czech Republic

Background. In renal transplant patients with stable graft function, triple-drug immunosuppression may not be necessary, while withdrawal of steroids may eliminate side effects. The primary aim of this study was to assess the risk of rejection after steroid withdrawal.

Methods. A total of 88 patients with stable graft function and serum creatinine <160 µmol/l, treated with cyclosporin A, azathioprine and prednisone were randomized into group A (n=46) with a gradual prednisone reduction to zero in the course of 6 months, and group B (n=42) on triple-drug therapy without change. At the time of randomization, fine-needle aspiration biopsy (FNAB) was carried out in all of the patients. After stopping steroids, the patients were followed up for a period of 12 months.

Results. Four patients failed to complete steroid withdrawal, three due to rejection, and one due to leukopenia. The proportion of rejection in three patients in group A (6.6%) was not significantly different from rejection in two patients in group B (4.8%). The mean value of serum creatinine was not significantly different in both groups in the course of follow-up. A finding of some degree of immunological activity in FNAB was made in four patients in each group, but none of these patients developed rejection. Compared with group B, significant decreases in serum cholesterol and blood leukocytes were observed in group A. Prednisone withdrawal did not have any influence on hypertension and serum triglycerides.

Conclusions. Gradual withdrawal of steroids is not associated with a higher risk for rejection and has a beneficial effect on serum total cholesterol levels. FNAB was not a useful tool for predicting rejection.

Keywords: fine-needle aspiration biopsy; immunosuppressive treatment; kidney transplantation; rejection; steroid withdrawal; triple-drug therapy

Correspondence and offprint requests to: Ivo Matl, Vídenská 1958/9, 14021 Prague 4, Czech Republic.


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J. M. Grinyo
Steroid sparing strategies in renal transplantation
Nephrol. Dial. Transplant., October 1, 2005; 20(10): 2028 - 2031.
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