Tj. Elias et al., Excellent long-term graft survival in low risk, primary renal allografts treated with prednisolone-avoidance immunosuppression, CLIN TRANSP, 14(2), 2000, pp. 157-161
Primary avoidance of oral corticosteroids for renal transplant recipients i
s uncommon. The South Australian renal transplant service used a double the
rapy (DT) regimen of cyclosporin and azathioprine from August 1986 to July
1996 for low risk (first graft, PRA < 50%) allografts. Oral corticosteroid,
prednisolone (P), was reserved for severe rejection or two mild rejection
episodes, but could be later withdrawn at the physician's discretion. This
regimen is associated with more early acute rejection (Russ et al., Clin Tr
ansplant 1990. 4: 26). We have now analysed long-term patient survival (PS)
and graft survival (GS) for this group. Of 448 transplants in South Austra
lia between August 1986 and July 1996, 295 commenced DT regimen. Ninety-fou
r (31.8%) never received P at any stage post-transplantation (group 1), 96
(32.5%) were placed on P and later weaned (group 2), and 97 (33%) remained
on long-term P (group 3). Technical losses, eight (2.7%), within 30 d of tr
ansplantation, were excluded from sub-group analysis. PS for the total DT c
ohort at 1, 5 and 9 yr post-transplantation was 97. 88 and 74%, respectivel
y. GS over the same time period was 88, 75 and 55%, respectively. There was
no statistically significant difference in survival compared to other 'low
risk' grafts in the rest of Australia during the same time period. Mean se
rum creatinine concentration (CrC) for the DT group at 3 and 6 months and 1
, 3, 5 and 10 yr was not significantly different to the rest of the Austral
ian 'low risk' grafts. In the DT cohort, there were 334 acute rejections (
< 90 d) in 206 patients (70%), but only 42 (12.5%) required anti-lymphocyte
antibody therapy (OKT3 or ATG) for rejection. PS at 9 yr was not statistic
ally significantly different between groups 1 and 2, but both groups surviv
ed better than group 3 (p < 0.0043). GS for group 1 at 1, 5 and 9 yr post-t
ransplantation was 90, 81 and 73%, respectively; for group 2, 98, 87 and 66
%, respectively; and for group 3, 84, 63 and 29%, respectively. Statistical
significance was reached in group 1 versus 3 (p < 0.001) and group 2 versu
s 3 (p < 0.001). Tn summary, a DT regimen in low risk, first renal allograf
ts gives excellent long-term patient and GS and minimises long-term P, desp
ite a high rate of early acute rejection.