N. Taylor1, A. Fagenson1, K. Lau1, A. Di Carlo1, A. Diamond1, S. Karhadkar1 1Temple University,SURGERY / ABDOMINAL ORGAN TRANSPLANTATION,Philadelpha, PA, USA
Introduction:
Corticosteroids are a pharmacological staple for prevention of graft rejection in renal transplantation. Deleterious effects of long term steroid use have prompted attempts to implement maintenance immunosuppression protocols that minimize steroids with little success due to higher rejection rates. Furthermore, other factors such as African American race are postulated to increased rates of rejection. Conventionally, this has resulted in reluctance to use steroid-free or steroid minimization protocols in African American patients. We sought to determine whether steroid-free or steroid minimization protocols resulted in increased negative outcomes in African American patients when compared to their non-African American counterparts.
Methods:
A retrospective review of all consecutive renal transplantation patients at an Urban University Hospital from 2013 through 2018 was performed. Patients were stratified by race. Continuous variables were compared using student independent t-tests and categorical variables were compared using Chi-squared and Fischer exact tests. Patients were further grouped based on steroid minimization maintenance protocol (no more than 5mg of prednisone per day) and steroid-free maintenance protocol.
Results:
A total of 227 kidney allograft recipients were identified; 124 (54.6%) African Americans and 103 (45.4%) non-African Americans. There were significantly more non-African American patients that received steroid minimization maintenance immunosuppression protocol (n=86, 30.8% AA vs 51.6% non-AA, p = 0.002). Additionally, 34 patients received a steroid-free maintenance immunosuppression protocol. There were no racial disparities in this group. Initiation of steroid minimization and steroid free protocols was based on identification of risk factors for acute rejection such as PRA, prior renal transplant and presence of donor specific antibodies.
Overall, the African American group had more episodes of acute rejection (22.1% AA vs 10.2% non-AA; p=0.019) for all comers, irrespective of steroid utilization. Of the patients that underwent a steroid minimization protocol there was no difference in acute rejection between the African American and non-African American groups. Of the patients that underwent a steroid-free protocol there was no difference in acute rejection or graft failure between the African American and non-African groups.
Conclusion:
Contrary to the notion that African American patients should remain on corticosteroids during the maintenance period, our data suggests that there is no significant increase in risk of rejection when African American patients undergo steroid minimization or steroid-free maintenance immunosuppression protocols following renal transplantation. Other factors such as drug compliance and pharmacodynamics may play a role in immune modulation in this group of patients.
