E. Tay1, A. Koi1, J. Johnson1, T. Engebretsen1, M. Mujtaba2, H. Stevenson3, M. Kueht1 1University Of Texas Medical Branch, Surgery, Galveston, TX, USA 2University Of Texas Medical Branch, Transplant Nephrology, Galveston, TX, USA 3University Of Texas Medical Branch, Transplant Pathology, Galveston, TX, USA
Introduction: The purpose of this paper is to investigate the effect of early steroid withdrawal (ESW) vs. steroid continuous immunosuppression (SCI) on one-year post-transplant outcomes in African American/black(AA/b) renal transplant recipients as this population has historically been considered high immunologic risk. Therefore, prolonged steroids have become a more common therapy in this population; risks and benefits need to be analyzed to take better care of minority populations.
Methods: We used the TriNetX database to conduct a case-control study of one-year renal transplant outcomes in AA/b patients who underwent ESW versus SCI. ESW was defined as a one-year maintenance regimen with tacrolimus (tac) and mycophenolate mofetil (MMF) or mycophenolic acid (MMP) with no prednisone. SCI was defined as a one-year maintenance regimen with tac + MMF or MMP + prednisone. Cohorts were matched on age, sex, etiologies of end-stage renal disease, BMI, and diabetes mellitus. Primary outcomes included rejection, graft failure (eGFR <15), and mortality. Secondary outcomes included opportunistic viral infections.
Results: There were 392 patients in each cohort after matching. The mean age was 48.1 +/- 12.7 years old and 61.7% were male. Kaplan-Meier analysis showed SCI did not have significantly higher incidences of rejection compared to ESW (32.30% in ESW vs. 32.27% in SCI, p=0.696) or mortality (1.53% in ESW vs. 1.29% in SCI, p=0.760.) There was a significantly higher incidence of graft failure in the SCI vs ESW cohort (9.71% in ESW vs 17.64% in SCI, p=0.001). The SCI cohort had a significantly higher incidence of composite viremia (CMV, EBV, BK, JC, VZV) (18.54% in ESW vs. 30.55% in SCI, p <0.01.)
Conclusions: Steroids are more commonly prescribed to AA/b renal transplant recipients, rooted in the belief they have increased immunological risk. Based on this study, ESW did not significantly increase the incidence of rejection or mortality in AA/b patients. There is a higher incidence of viremia in the SCI population, and there was a significantly higher graft failure in SCI in comparison with ESW cohort one year post-transplant. There is a need for further studies on this topic as long steroid treatments can cause more complications, and their use might be increased in minority populations.