Safety and Efficacy of Early Steroid Withdrawal with Thymoglobuline Induction in Kidney Transplantation

Chang, Young Woo; Park, Kwan Tae; Kim, Young Hoon; Kim, Song Chul; Shin, Hye Won; Han, Duck Jong

Abstract

BACKGROUND: We report our experiences of early steroid withdrawal using thymoglobuline induction in kidney transplant patients to verify the efficacy and safety of steroid minimization protocol that can prevent long term complications of steroid.
METHODS
From December 2002 to July 2007, 36 kidney transplants were performed at our institution using the steroid early withdrawal protocol with 5 doses induction of thymoglobuline (50 mg IV), and maintaining with tacrolimus/ cyclosporine and mycophenolate mofetil (MMF)/azathioprine. Control group was 80 kidney transplant recipients on conventional triple immunosuppression protocol without antibody induction.
RESULTS
Donor and recipient's profiles in both groups were not different except more proportion of diabetic patients and immunosuppression using tacrolimus and MMF in PD free group. The rejection rate was 13.8% and 16.3% in PD free and PD groups respectively. Two years graft and patients survival rate were 96.4%/100% in PD free group and 97.5%/97.5% in PD group. Serum creatinine level was similar between the two groups and WBC count was lower in PD free group up to postoperative 6 months. 72.2% of PD free group remained steroid free by the last follow up.
CONCLUSIONS
Early steroid withdrawal with thymoglobulin induction can be applied safely with acceptable success rate with minimizing adverse effects of steroid in kidney transplantation patients. But early steroid withdrawal protocol should be adopted cautiously in immunologically high risk patients.