A comparative analysis of kidney allograft outcomes in steroid use versus steroid discontinuation after basiliximab and ATG induction: A UNOS database study.

التفاصيل البيبلوغرافية
العنوان:	A comparative analysis of kidney allograft outcomes in steroid use versus steroid discontinuation after basiliximab and ATG induction: A UNOS database study.
المؤلفون:	Nissaisorakarn P, Patel H, Cardarelli F, Amtul A
المصدر:	Clinical nephrology [Clin Nephrol] 2024 Jul; Vol. 102, pp. 39-50.
نوع المنشور:	Journal Article; Comparative Study
اللغة:	English
بيانات الدورية:	Publisher: Dustri-Verlag Dr. Karl Feistle Country of Publication: Germany NLM ID: 0364441 Publication Model: Print Cited Medium: Internet ISSN: 0301-0430 (Print) Linking ISSN: 03010430 NLM ISO Abbreviation: Clin Nephrol Subsets: MEDLINE
أسماء مطبوعة:	Original Publication: München-Deisenhofen, Dustri-Verlag Dr. Karl Feistle.
مواضيع طبية MeSH:	Kidney Transplantation* , Basiliximab/therapeutic use , Basiliximab/administration & dosage , Antilymphocyte Serum/therapeutic use , Antilymphocyte Serum/administration & dosage , Immunosuppressive Agents/therapeutic use , Immunosuppressive Agents/administration & dosage , Graft Rejection/prevention & control , Graft Survival/drug effects, Humans ; Male ; Retrospective Studies ; Female ; Middle Aged ; Adult ; Databases, Factual ; Recombinant Fusion Proteins/administration & dosage ; Recombinant Fusion Proteins/therapeutic use ; Treatment Outcome ; Steroids/administration & dosage ; Steroids/therapeutic use ; Allografts ; Time Factors
مستخلص:	Background and Objectives: The relative safety and efficacy of early steroid withdrawal in kidney transplant patients after basiliximab compared to anti-thymocyte globulin (ATG) induction therapy is unknown. We aimed to compare kidney allograft outcomes in steroid use versus steroid discontinuation after basiliximab and ATG induction from the United Network for Organ Sharing (UNOS) database. Materials and Methods: We conducted a retrospective cohort analysis of the UNOS database and included first kidney transplant recipients who received ATG or basiliximab induction therapy. We compared graft and patient outcomes in those who received steroid maintenance and those who were discharged off steroids. Results: Of 106,061 patients, 25,344 (86.7%) received basiliximab induction and were maintained on steroids (B-Sm), and 3,880 (13.3%) were on a steroid-free regimen (B-Sf). Graft failure rate was significantly higher in the B-Sf compared to B-Sm at 1-year (4.1 vs. 1.8%, p < 0.001), 3-year (6.0 vs. 4.3%, p < 0.001) and 5-year follow-up (7.7 vs. 6.4%, p = 0.0004). The mortality rate was significantly higher in B-Sf at 1-year (3.3 vs. 2.4%, p = 0.0005), 3-year (7.6 vs. 5.5%, p < 0.001) and 5-year follow-up (11.5 vs. 8.8%, p < 0.001) when compared to the B-Sm. 76,837 recipients received ATG induction therapy, 51,745 (72.4%) were on steroid maintenance therapy (A-Sm) and 25,092 (32.6%) were on a steroid-free regimen (A-Sf). The graft failure rate was significantly higher in A-Sf compared to A-Sm at 1-year follow-up (2.6 vs. 2.3%, p = 0.0006), however, there was no difference at 3-year (5.0 vs. 5.0%, p = 0.53) or 5-year follow-up (7.2 vs. 8.1%, p = 0.17). There was no difference in mortality rates between A-Sf vs. A-Sm at 1 year (2.5 vs. 2.4%, p = 0.98) and at 3 years (5.5 vs. 5.4%, p = 0.45), respectively. Conclusion: Patients who were maintained on steroids after basiliximab induction had better 5-year allograft survival and patient survival compared to those who were not maintained on steroids. However, steroid maintenance conferred no additional benefit after ATG induction and was associated with higher mortality.
المشرفين على المادة:	9927MT646M (Basiliximab) 0 (Antilymphocyte Serum) 0 (Immunosuppressive Agents) 0 (Recombinant Fusion Proteins) 0 (Steroids)
تواريخ الأحداث:	Date Created: 20240503 Date Completed: 20240625 Latest Revision: 20240625
رمز التحديث:	20240625
DOI:	10.5414/CN111033
PMID:	38699983
قاعدة البيانات:	MEDLINE

الوصف
تدمد:	0301-0430
DOI:	10.5414/CN111033