Recurrent Glomerulonephritis Under Rapid Discontinuation of Steroids

被引:31
作者
Kukla, Aleksandra [1 ]
Chen, Eric [1 ]
Spong, Richard [1 ]
Weber, Marc [1 ]
El-Shahawi, Yasser [1 ]
Gillingham, Kristen [2 ]
Matas, Arthur J. [2 ]
Ibrahim, Hassan N. [1 ]
机构
[1] Univ Minnesota, Div Renal Dis & Hypertens, Minneapolis, MN 55414 USA
[2] Univ Minnesota, Dept Surg, Minneapolis, MN 55414 USA
关键词
Kidney transplant; Recurrent glomerulonephritis; Steroid avoidance; Graft survival; GRAFT LOSS; IMMUNOSUPPRESSION; TRANSPLANTATION; PROTEINURIA; PREDICTORS; CONVERSION; SIROLIMUS; OUTCOMES;
D O I
10.1097/TP.0b013e31821bf157
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Background. Recurrent glomerulonephritis (GN) remains an important cause of kidney allograft loss and whether rapid discontinuation of steroids (RDS) is associated with a higher risk of recurrence is not known. Methods. We studied recurrence rate, and graft and patient survival in four groups of recipients: 216 recipients with GN transplanted under RDS (group 1), 978 concurrent non-GN recipients transplanted under RDS (group 2), 260 historic comparator group transplanted for GN between 1994 and 1999 with steroid maintenance (group 3), and 950 recipients who were also transplanted between 1994 and 1999 for non-GN and also maintained on steroids (group 4). Regression analysis adjusting for donor and recipient factors, steroid and sirolimus use, and also GN type was used to address factors associated with recurrent disease. Results. The 1-, 5-, and 7-year recurrence rate in the GN group under RDS was 6.7%, 13.7%, and 19.2% and in historic GN recipients maintained on steroids it was 2.4%, 3.8%, and 5.3%, respectively (P<0.0001). RDS was associated with a higher adjusted risk of recurrent disease for all GN types (hazard ratio 4.86; 95% confidence interval 2.34-10.07; P<0.0001). Graft and patient survival were similar in the two GN groups and both were highest among all groups. Notably, death-censored graft survival was not different among the groups. Conclusion. Steroid avoidance may be associated with a higher rate of recurrent GN but no apparent increase in risk of graft loss. This group of recipients needs to be studied more carefully, in larger numbers, and for a longer time period.
引用
收藏
页码:1386 / 1391
页数:6
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