CLINICAL IMMUNOSUPPRESSION - KIDNEY EARLY

S. Gulati, V. Saxena, S. Pokhariyal, S.B. Bansal, R. Alhawat, V. Kher
Nephrology, FORTIS INSTITUTE OF RENAL SCIENCES AND TRANSPLANTATION, VASANT KUNJ, NEW DELHI/INDIA

Body: Introduction: Availability of many potent newer immunosuppressive drugs including induction agents and to avoid the undesirable chronic adverse effects of steroids has lead to the use of steroid avoidance immunosuppressive protocols. Patient & Methods: We prospectively evaluated 42 renal transplant recipients who were initiated on steroid free protocol. Selection of patients was done following discussion with them and their desire to avoid steroids. All patients who had history of prolonged exposure to steroids in the past or were second transplants were excluded. All of the patients in the study group received two doses of IL2RA as induction. They were given IV Methylprednisolone in an initial dose 500 mg followed by oral prednisolone starting post operative day 1 at 40 mg/day which was tapered and stopped by day 5. All of them received Tacrolimus (0.1 mg/kg) and MMF as maintenance immunosuppression. At each visit they were assessed clinically for height, weight, BP and biochemical investigations (BUN, S. Creatinine, Na, K, Blood sugar). The outcome measures that were evaluated were number of acute rejections, infections, graft loss, PTDM, requirement of antihypertensive medications and S. Cholestrol and LDL levels. We compared the outcome of the patients on steroid free protocol with 40 patients who received IL-2RA, Tacrolimus, MMF and steroids. Fisher exact test’ and ‘Chi Square’ were used for statistical analysis and a P value <0.05 was considered significant. Results : The study group comprised of 42 patients (26 males & 16 females), mean age was 39 + 14.4 years . the demographic characteristics were similar in the control gp (mean age 40.9 + 13. 5 yr s, 31 males and 9 females) The mean follow up was 196 + 175.6 days . Six patients (14.2%) had an episode of AR and all of them were treated with IV methylprednisone followed by oral prednisone therapy as maintenance. The incidence of rejections was similar in the study group as compared to those who were on steroid based protocols (5/40 (12.5%) (p=1.0). All of them responded and regained baseline renal functions. The mean s.creatinine at last follow-up was 1.23 + 0.43 mg/dl. Of the 42 patients, 11 had one or more episode of infections with UTI being the commonest (9/11). The incidence of infections was similar in the study group as compared to those who were on steroid based protocols (5/40 ,12.5%) (p=0.43). None of these 42 pateints developed PTDM as compared to 3/ 40 in the control gp (p=0.11). There was no death or graft loss in the steroid free group. The incidence of graft loss ( 0/42 vs 2/40, p=0.23) and death ( 0/42 vs 1/40, p=1.0) were similar in the two groups. Of the 42 patients, 33.3% did not require antihypertensive medications. All the 3 children who were on steroid free protocol showed an excellent growth with mean growth velocity of 6.8 cm/yr. Conclusions: This initial experience suggests that steroid free protocol is safe and efficacious to avoid steroid induced adverse effects without any sgnificantly increased incidence of acute rejection.

Disclosure: All authors have declared no conflicts of interest.