AIM: To analyze the impact of steroid maintenance on the outcomes in kidney transplant recipients stratified by induction agent received.METHODS: Patients who underwent first-time deceased donor kidney transplantation...AIM: To analyze the impact of steroid maintenance on the outcomes in kidney transplant recipients stratified by induction agent received.METHODS: Patients who underwent first-time deceased donor kidney transplantation between 2000 and 2008 after receiving induction therapy with rabbitantithymocyte globulin(r-ATG), alemtuzumab or an interleukin-2 receptor blocker(IL-2B) and discharged on a calcineurin inhibitor(CNI)/mycophenolate mofetil(MMF)-regimen along with or without steroids were identified from the Organ Procurement and Transplant Network/United Network of Organ Sharing database.For each induction type, adjusted overall and deathcensored graft as well as patient survivals were compared between patients discharged on steroid vs no steroid. Among r-ATG induced patients, analysis was repeated after splitting the group into low and high immune risk groups.RESULTS: Among the 37217 patients included in the analysis, 17863 received r-ATG(steroid = 13001, nosteroid = 4862), 3028 alemtuzumab(steroid = 852, no-steroid = 2176) and 16326 IL-2B(steroid = 15008, no-steroid = 1318). Adjusted overall graft survival was inferior(HR = 1.16, 95%CI: 1.06-1.27, P = 0.002) with similar death-censored graft survival(HR = 0.99, 95%CI: 0.86-1.14, P = 0.86) for steroid vs no-steroid groups in r-ATG induced patients. Both adjusted overall and death-censored graft survivals for steroid vs nosteroid groups were similar in alemtuzumab(HR = 0.92, 95%CI: 0.73-1.15, P = 0.47 and HR = 0.87, 95%CI: 0.62-1.22, P = 0.43 respectively) and IL-2B(HR = 1.05, 95%CI: 0.91-1.21, P = 0.48 and HR = 0.94, 95%CI: 0.75-1.18, P = 0.60 respectively) induced groups. Adjusted patient survivals were inferior for steroid vs nosteroid groups in r-ATG induced(HR = 1.31, 95%CI: 1.15-1.49, P < 0.001) but similar in alemtuzumab(HR = 1.02, 95%CI: 0.75-1.38, P = 0.92) and IL-2B(HR = 1.17, 95%CI: 0.97-1.40, P = 0.10) induced patients. Among the r-ATG induced group there were 4346 patients in the low immune risk and 13517 patients in the high immune risk group. Adjusted展开更多
基金Supported by Health Resources and Services Administration Contract 231-00-0115
文摘AIM: To analyze the impact of steroid maintenance on the outcomes in kidney transplant recipients stratified by induction agent received.METHODS: Patients who underwent first-time deceased donor kidney transplantation between 2000 and 2008 after receiving induction therapy with rabbitantithymocyte globulin(r-ATG), alemtuzumab or an interleukin-2 receptor blocker(IL-2B) and discharged on a calcineurin inhibitor(CNI)/mycophenolate mofetil(MMF)-regimen along with or without steroids were identified from the Organ Procurement and Transplant Network/United Network of Organ Sharing database.For each induction type, adjusted overall and deathcensored graft as well as patient survivals were compared between patients discharged on steroid vs no steroid. Among r-ATG induced patients, analysis was repeated after splitting the group into low and high immune risk groups.RESULTS: Among the 37217 patients included in the analysis, 17863 received r-ATG(steroid = 13001, nosteroid = 4862), 3028 alemtuzumab(steroid = 852, no-steroid = 2176) and 16326 IL-2B(steroid = 15008, no-steroid = 1318). Adjusted overall graft survival was inferior(HR = 1.16, 95%CI: 1.06-1.27, P = 0.002) with similar death-censored graft survival(HR = 0.99, 95%CI: 0.86-1.14, P = 0.86) for steroid vs no-steroid groups in r-ATG induced patients. Both adjusted overall and death-censored graft survivals for steroid vs nosteroid groups were similar in alemtuzumab(HR = 0.92, 95%CI: 0.73-1.15, P = 0.47 and HR = 0.87, 95%CI: 0.62-1.22, P = 0.43 respectively) and IL-2B(HR = 1.05, 95%CI: 0.91-1.21, P = 0.48 and HR = 0.94, 95%CI: 0.75-1.18, P = 0.60 respectively) induced groups. Adjusted patient survivals were inferior for steroid vs nosteroid groups in r-ATG induced(HR = 1.31, 95%CI: 1.15-1.49, P < 0.001) but similar in alemtuzumab(HR = 1.02, 95%CI: 0.75-1.38, P = 0.92) and IL-2B(HR = 1.17, 95%CI: 0.97-1.40, P = 0.10) induced patients. Among the r-ATG induced group there were 4346 patients in the low immune risk and 13517 patients in the high immune risk group. Adjusted
