Withdrawal of steroids from triple-drug therapy in kidney transplant patients

Background. In renal transplant patients with stable graft function, triple -drug immunosuppression may not be necessary, while withdrawal of steroids may eliminate side effects. The primary aim of this study was to assess the risk of rejection after steroid withdrawal. Methods. A total of 88 patients with stable graft function and serum creati nine <160 mu mol/l, treated with cyclosporin A, azathioprine and prednisone were randomized into group A (n=46) with a gradual prednisone reduction to zero in the course of 6 months, and group B (n=42) on triple-drug therapy without change. At the time of randomization, fine-needle aspiration biopsy (FNAB) was carried out in all of the patients. lifter stopping steroids, t he patients were followed up for a period of 12 months. Results. Four patients failed to complete steroid withdrawal, three due to rejection, and one due to leukopenia. The proportion of rejection in three patients in group A (6.6%) was not. significantly different from rejection in two patients in group B (4.8%). The mean value of serum creatinine was n ot significantly different in both groups in the course of follow-up. A fin ding of some degree of immunological activity in FNAB was made in four pati ents in each group, but none of these patients developed rejection. Compare d with group B, significant decreases in serum cholesterol and blood leukoc ytes were observed in group A. Prednisone withdrawal did not have any influ ence on hypertension and serum triglycerides. Conclusions. Gradual withdrawal of steroids is not associated with a higher risk for rejection and has a beneficial effect on serum total cholesterol levels. FNAB was not a useful tool for predicting rejection.