African-American renal transplant recipients benefit from early corticosteroid withdrawal under modern immunosuppression

TitleAfrican-American renal transplant recipients benefit from early corticosteroid withdrawal under modern immunosuppression
Publication TypeJournal Article
Year of Publication2005
AuthorsBoardman RE, Alloway RR, Alexander JW, Buell JF, Cardi M, First MR, Hanaway MJ, Munda R, Rogers CC, Roy-Chaudhury P, Susskind B, Trofe J, Woodle ES
JournalAm J Transplant
Volume5
Issue2
Pagination356 - 65
Date PublishedFeb
Accession Number15643996
Keywords*Kidney Transplantation, Adrenal Cortex Hormones / *pharmacology, African Americans, Graft Rejection / drug therapy / epidemiology, Graft Survival / drug effects, Humans, Immunosuppression, Survival, Time Factors
Abstract

African-Americans (AAs) have historically been considered high-risk renal transplant recipients due to increased rejection rates and reduced long-term graft survival. As a result, AAs are often excluded from corticosteroid withdrawal (CSWD) protocols. Modern immunosuppression has reduced rejections and improved graft survival in AAs and may allow successful CSWD. Outcomes in 56 AAs were compared to 56 non-AAs. All patients were enrolled in one of four early CSWD protocols. Results are reported as AA versus non-AA. Acute rejection at 1-year was 23% and 18%; (p = NS); creatinine clearance at 1-year was 75 versus 80 mL/min (p = NS); patient and graft survival was 96% versus 98% and 91% versus 91%; (p = NS). AAs benefit from early CSWD with significantly improved blood pressure, LDL 45 mg/dL at 1-year, post-transplant diabetes of 8.7%, and mean weight change at 1-year of 4.8 +/- 7.2 kg. In conclusion, early CSWD in AAs is associated with acceptable rejection rates, excellent patient and graft survival, and improved cardiovascular risk, indicating that the risks and benefits of early CSWD are similar between AAs and non-AAs. Additional follow-up is needed to determine long-term renal function, graft survival, and cardiovascular risk in AAs with early CSWD.

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