Present address: Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104-4322, USA.
Simultaneous corticosteroid avoidance and calcineurin inhibitor minimization in renal transplantation
Article first published online: 27 MAR 2006
Volume 19, Issue 4, pages 295–302, April 2006
How to Cite
Wesley Alexander, J., Goodman, H. R., Cardi, M., Austin, J., Goel, S., Safdar, S., Huang, S., Munda, R., Fidler, J. P., Buell, J. F., Hanaway, M., Susskind, B., Roy-Chaudhury, P., Trofe, J., Alloway, R. and Steve Woodle, E. (2006), Simultaneous corticosteroid avoidance and calcineurin inhibitor minimization in renal transplantation. Transplant International, 19: 295–302. doi: 10.1111/j.1432-2277.2006.00280.x
- Issue published online: 27 MAR 2006
- Article first published online: 27 MAR 2006
- Received: 1 October 2005 Revision requested: 4 November 2005 Accepted: 9 January 2006
- calcineurin inhibitors;
- kidney transplantation;
- steroid avoidance
Steroids and calcineurin inhibitors (CNI) have been mainstays of immunosuppression but both have numerous side effects that are associated with substantial morbidity and mortality. This study was carried out to determine if steroids can be eliminated with early discontinuation of cyclosporine A (CsA) and later discontinuation of mycophenolate mofetil (MMF). Ninety-six patients with kidney transplants were entered into four subgroups of two pilot studies. All patients received Thymoglobulin® induction, rapamycin (RAPA), and the immunonutrients arginine and an oil containing ω-3 fatty acids. Mycophenolate mofetil was started in standard doses and discontinued by 2 years. CsA was given in reduced doses for either 4, 6, or 12 months. Follow-up was 12–36 months. Thirteen first rejection episodes occurred during the first year (14%). Combining all patients, 86% were rejection-free at 1 year, 80% at 2 years and 79% at 3 years. No kidney has been lost to acute rejection. Ninety percent of the 84 patients at risk at the end of the study were steroid-free and 87% were off CNI. Fifty-seven percent of 54 patients with a functioning kidney at 3 years were receiving monotherapy with RAPA. We conclude that this therapeutic strategy is worthy of a prospective multi-center clinical trial.