Steroid Reduction Lowers Toxic Effects in Kidney Transplants

Preliminary results of a new study suggest that reducing corticosteroid treatment in kidney transplant patients significantly lowers the toxic side effects of anti-rejection drugs without affecting survival rates.

Researchers at the University of Cincinnati (UC, OH, USA) followed 397 patients enrolled in a national study conducted at 26 medical centers across the United States, who were then randomized to either a seven-day or lifetime course of corticosteroid therapy, which started within the first three days of transplant. Patients in both treatment groups received the steroids in combination with twice-daily tacrolimus and mycophenolate mofetil, immunosuppressive agents designed to help lower the body's natural immunity to the transplant organ.

The study found that patients who received just seven days of the corticosteroid prednisone after kidney transplant had the same transplant organ survival rate and functionality as those placed on continuous corticosteroids. The study found that biopsy-proven acute rejection rate for steroid-free patients was 16%, only slightly higher than the nationwide average of 15%. Steroid-free patients, however, experienced significantly less cardiovascular risk, including cholesterol levels, blood pressure, and weight gain.

In addition, UC researchers found that African-Americans--long excluded from transplant research trials because of a perceived risk for increased acute rejection--are not at any greater risk for rejection than Caucasians and actually enjoy even greater benefits in terms of cardiovascular risk reduction. The results presented were for the first three years of the projected five-year investigation. The study was reported at the World Transplant Congress, the first international joint-organizational transplant conference, held in July 2006 in Boston (MA, USA).

"When you ask transplant patients about their medicines, they say the drug they dislike most is steroids. They don't want to take steroids because of what the drugs do to their bodies,” said lead author Steve Woodle, M.D., director of transplantation at UC. "They see how the drug's toxicity affects their bodies--their faces swell, they gain weight, they bruise easily--and they know steroids are the cause.”



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