In a new research presented at the American Transplant Congress on May 30 to June 1, 2020, it was shown that early steroid withdrawal was linked with an increased chances of acute graft rejection following a year after kidney transplantation.

Dr William A. Werbel from John Hopkins Universitymentioned that, “kidney transplant has been proven to be safe and effective for persons with HIV and end-stage renal disease with excellent long-term patient and graft survival. Acute rejection has however been demonstrated to be more common in HIV -positive vs. HIV-negative recipients for as yet unclear reasons.”

In spite of corticosteroids being the cornerstone in maintenance immunosuppression after transplant and are effective anti-rejection agents, yet they are also linked with several cardiometabolic and infectious complications after kidney transplantation. It has been a clinical practice to restrict the use of corticosteroids in HIV positive transplant patients by initiating an early withdrawal. In this study where the researchers obtained data from the Scientific Registry of Transplant Recipients, including 1, 123 recipients who had no rejection or graft loss during transplant hospitalization and those who were discharged on calcineurin inhibitors and mycophenolate. The findings showed that at 6 months, early steroid withdrawal was related to 62% higher odds of acute rejection. At the end of a year, early withdrawal was associated with 57% higher odds. The increased risk of rejection exists despite reduced risk profiles and more transplantation with kidneys from living donors.

The authors concluded that customizing early steroid withdrawal interventions to a particular patient may play a substantial role in improving the quality of care, citing examples of reducing both hospitalizations and complications related to acute rejection.

Source: Werbel WA, et al. Poster #331. Presented at: American Transplant Congress; May 30 to June 1, 2020. (Virtual meeting)