Discontinuation of Steroids After Kidney Transplant Safe

Patients who discontinue taking the immunosuppressant prednisone after kidney transplant avoid the long term adverse effects of steroids without risking their new organs, a 10-year study found.

Side effects including transplant glucose intolerance and new-onset diabetes mellitus, cataracts, and avascular necrosis are associated with the prolonged use of high doses of prednisone inherent in immunosuppressive protocols for kidney transplant recipients. 

Between 1999 and 2010, Arthur J Matas, MD, of the University of Minnesota in Minneapolis, and colleagues discontinued prednisone after postoperative day 5 in 1241 cases (791 living donor, 450 deceased donor) of adult primary kidney transplant. 

The 10-year actuarial patient survival rate was 71% among living donor patients and 62% among deceased donor patients.  All patients showed lower rates of cataracts after 10 years (less than 5% among living donors and 15% among deceased donors), as well as decreased rates of avascular necrosis among non-diabetic patients. 

Graft survival rates “remained acceptable”, with 61% actuarial survival at 10 years of living donor recipients and 51% for deceased donor recipients. 

“Prednisone-related side effects can be minimized in a protocol incorporating rapid discontinuation of prednisone for maintenance immunosuppression. Ten-year patient and graft outcomes remain acceptable,” the study concludes. 

-Michael Potts