Long-term outcome of a prospective trial of steroid withdrawal after kidney transplantation

Background. Steroid withdrawal (SW) after kidney transplantation is desirab le to avoid associated serious sine effects. We studied the long-term outco me of a group of kidney transplant recipients who underwent went SW. Methods. Between 1991 and 1993, kidney transplant recipients (N = 12) who h ad posttransplantation diabetes were entered in a prospective trial of SW. These patients were compared with a demographically similar comparison coho rt (N = 66). End points of the study were patient and graft survival, incid ence of late acute and chronic rejection, and changes in diabetes managemen t. Results, Previously published data from the SW group at 15 months of follow -up indicated improvement in diabetes control without any adverse effect on patient or graft actuarial survival. At long-term follow-up (mean, 56 mont hs) the improvement in diabetes management was not detectable. The incidenc e of late acute rejection in SW and cohort groups was 42% and 8%, respectiv ely (P = .006). Likewise, the incidence of chronic rejection in the SW vers us cohort group was 42% and 12%, respectively (P = .014). Conclusions. Although SW appeared to be successful initially, our long-term data indicate that SW significantly increases the risk of late acute rejec tion and chronic rejection episodes without benefits in posttransplantation diabetes management. Steroid withdrawal in patients with posttransplantati on diabetes should be approached with caution.