Monitoring immune function after rapid corticosteroid reduction in kidney transplant recipients

Background Long-term use of steroid with large dosage might cause many adverse effects in kidney transplant patients; reducing steroid dosage to a low level for maintenance is helpful in avoiding the side-effects, but meanwhile, acute rejection may rise to be a main concern. The present research monitored the immune function changes and the incidence of acute rejection and infection after rapid steroid reduction to investigate the safety of this strategy. Methods A prospective trial was conducted, using tacrolimus and mycophenolate mofetil as the basic immunosuppressive regimen, in addition to antibody induction with basiliximab. Corticosteroid dosage was rapidly reduced to 10 mg/d seven days post-transplantation in the experimental group, and the standard corticosteroid therapy was employed in the control group. Patient immunity was monitored by the Immune Cell Function Assay pre- and two weeks post-transplantation. The incidence of acute rejection and infection were compared between the experimental and control group. Results Comparison of intracellular adenosine triphosphate (iATP) values detected two weeks post-transplantation for the control group ((324 +/- 45) ng/ml) and the experimental group ((345 +/- 91) ng/ml) did not reveal a significant difference (P >0.05). The incidence of acute rejection was analogous between groups (P >0.05), while an increased incidence of infection was observed in the control group (53% (n=16)) versus the experimental group (22% (n=6), P <0.05). Overall, recipients in the control group had longer and more recurrent infections than those in the experimental group (P <0.05). Patients in the control group had a lower immune response ((235 35) ng/ml) than those in the experimental group ((286 +/- 16) ng/ml) when infection occurred (P <0.05). Conclusion Rapid reduction of steroid early after kidney transplantation does not lead to a significant rise in patient immunity. It is a safe and effective therapy for kidney transplant patients. Chin Med J 2011;124(5):679-682