Intermediate steroid withdrawal after renal transplantation and anti-HLA antibodies (HLA-Abs) development. 2017

Elena Monfá, and David San Segundo, and Juan Carlos Ruiz San Millán, and Judith Sanabria, and Zoila Albines, and Emilio Rodrigo, and Iñigo Romón, and Esther Asensio, and Manuel Arias, and Marcos López-Hoyos
Nephrology Department, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain. Electronic address: elenamonfa@gmail.com.

BACKGROUND Steroid withdrawal in renal transplantation is desirable to avoid their adverse effects. However, by decreasing the immunosuppression, could lead to an increased risk for the development of HLA-Abs. OBJECTIVE Evaluate the relationship between steroid withdrawal and development of HLA-Abs in renal transplantation. METHODS We analyzed sera by Luminex from 182 kidney transplants performed from 1998 to 2011, before and two years after transplantation. All the patients had a pretransplant PRA (panel reactive of antibodies) <20% by complement-dependent cytotoxicity (CDC) and maintenance immunosuppression with tacrolimus and mycophenolate mofetil (MMF). We compared a group of steroid withdrawal at 7 months (group-I; n=130) and another control with non-withdrawal (group-II; n=52). RESULTS 22 patients (16.9%) in group-I and 11 patients in group-II (21.1%) had HLA-Abs after two years (pNS). Despite excluding patients with PRA >20%, we detected HLA-Abs pretransplant by Luminex in 11.5% of patients in both groups, of which, 66.6%, versus 53% (p 0.058), developed new specificities, with a similar percentage of donor specific antibodies (DSA) in both groups (33.33% vs 36.36%), pNS. In the subgroup without pretransplant HLA-Abs (group-I; n=115, group-II; n=45), 6.08% developed de novo HLA-Abs, being DSA 3.4% (Group-I) versus 7.69% in group II with 3.84% DSA (pNS). CONCLUSIONS Steroid withdrawal at 7 months of renal transplantation does not entail a higher risk in terms of HLA-Abs development in patients without pretransplant HLA-Abs and treatment with tacrolimus and MMF, although larger studies are needed to confirm these findings.

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