03096nas a2200385   4500008003900000245015100039210006900190260000800259300001200267490000700279520173900286653007302025653003902098653004302137653003302180653005902213653003102272653003302303653001102336653004802347653002602395653004102421653002602462653000902488653003402497653001702531100001602548700001702564700001702581700001502598700001402613700002102627700001302648856004902661       2005                          d00aEarly corticosteroid withdrawal under modern immunosuppression in renal transplantation: multivariate analysis of risk factors for acute rejection0 aEarly corticosteroid withdrawal under modern immunosuppression i  cMar  a798 - 90 v373 aEarly corticosteroid withdrawal has been shown to be effective in low-risk patient populations in a number of US and European multicenter trials. However, patient populations traditionally considered to be at high risk for acute rejection (eg, African Americans, repeat transplant recipients, sensitized patients) are usually excluded from these trials. Since our initial experience with early withdrawal almost 10 years ago, we have included high-immunologic-risk patients. We have accumulated enough high-risk patients with early withdrawal to allow the first multivariate analysis of risk factors for acute rejection in early withdrawal under modern immunosuppression. METHODS: Early withdrawal was performed under prospective IRB-approved protocols. Statistical analysis included chi square test and logistic regression. All rejection episodes were biopsy proven and graded by Banff 1997 criteria. RESULTS: A total of 164 patients underwent early withdrawal: 82% had at least one mismatched DR antigen, 17% had delayed graft function, 33% were African American, and 18% were repeat transplant recipients. Multivariate analysis of risk factors for acute rejection indicated that two factors induced a statistically significant alteration in acute rejection risk: repeat transplant recipients (4.3-fold increased risk) and thymoglobulin induction (0.30 risk (ie, 70% reduction in risk compared to patients not receiving thymoglobulin induction). Sensitized recipients and African Americans were also at increased risk but did not quite reach statistical significance. These data strongly support the use of T-cell depleting antibody induction therapy in high-risk patients undergoing early withdrawal under modern immunosuppression.10aAdrenal Cortex Hormones / administration & dosage / *adverse effects10aAfrican Continental Ancestry Group10aAntilymphocyte Serum / adverse effects10aDrug Administration Schedule10aGraft Rejection / epidemiology / *prevention & control10aHistocompatibility Testing10aHLA-DR Antigens / immunology10aHumans10aImmunosuppressive Agents / *therapeutic use10aIsoantibodies / blood10aKidney Transplantation / *immunology10aMultivariate Analysis10aOhio10aReoperation / adverse effects10aRisk Factors1 aWoodle, E S1 aAlloway, R R1 aHanaway, M J1 aBuell, J F1 aThomas, M1 aRoy-Chaudhury, P1 aTrofe, J  uhttps://www.notifylibrary.org/reference/1648