Steroid-Sparing and Steroid-Based Immunosuppression in Kidney Transplant: Is There a Difference in Outcomes and Recipient Comorbidities?

OBJECTIVES: Corticosteroids are fundamental to immunosuppression in kidney transplant but have significant side effects, generating interest in steroid-sparing immunosuppression regimens. We studied corticosteroid withdrawal on graft outcomes and comorbidities to study individualized approaches for immunosuppression. This is the first study of its kind in our ethnically distinct population.

MATERIALS AND METHODS: Of 103 consecutive Saudi kidney transplant recipients seen in our unit during 2014-2018, 102 passed screening; 32 received no oral steroids after immunosuppression induction (steroid-spared group) and 70 received standard steroid-based immunosuppression. Both groups had similar immunosuppression induction: the standard steroid based immunosuppression included oral prednisolone (30 mg tapered to 5 mg over 6 wk), tacrolimus, and mycophenolate mofetil; however, the steroid-spared group did not receive corticosteroids after methylprednisolone induction. The Mann-Whitney U test compared numerical data, and the Fisher exact test compared categorical data. Relative risks for adverse events, graft dysfunction, and high serum creatinine were calculated. P < .05 was considered significant.

RESULTS: Compared with the steroid-based group, patients in the steroid-spared group were older, had higher mean body mass index, and more favorable human leukocyte antigen matching and panel reactive antibody profiles. Mean serum creatinine and proportion of recipients with above normal serum creatinine were greater in the steroid-based group; this group also had slightly higher incidence of acute rejection. No graft failures or recipient deaths occurred in either group. The steroid-based group had significantly greater weight gain than the steroid-spared group (67% vs 34%; P = .002). The steroid-spared group exhibited better control of blood pressure and serum lipids; however, this was not statistically significant.

CONCLUSIONS: Early steroid withdrawal in selected transplant recipients is a viable option for immunosuppression, with no compromised graft function or survival shown in our cohort. Given the significant impact of weight gain, blood pressure, and serum lipids on recipient morbidity and mortality, a larger study is warranted.