Rapid Discontinuation of Prednisone in Kidney Transplant Recipients: 15-Year Outcomes from the University of Minnesota.

Background: Short- and intermediate-term results have been reported after rapid discontinuation of prednisone (RDP) in kidney transplant recipients. Yet there has been residual concern about late graft failure in the absence of maintenance prednisone. Methods: From October 1, 1999, through June 1, 2015, we performed a total of 1553 adult 1st and 2nd kidney transplants-1021 with a living donor (LD), 532 with a deceased donor (DD)-under our RDP protocol. We analyzed the 15-year actuarial overall patient survival (PS), graft survival (GS), death-censored graft survival (DCGS), and acute rejection-free survival (ARFS) rates for RDP compared to historical controls on maintenance prednisone. Results: For LD recipients, the actuarial 15-year PS rates were similar between groups. But RDP was associated with increased GS (p=0.02) and DCGS (p=0.01). For DD recipients, RDP was associated with significantly better PS (p5 years, there was no difference between groups in subsequent actuarial PS, GS, and DCGS. Conclusion: In summary, at 15-years post kidney transplant, RDP did not lead to decreased in patient or graft survival, or an increase in graft dysfunction but as associated with reduced complication rates. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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