Steroid-free immunosuppression regime reduces both long-term cardiovascular morbidity and patient mortality in renal transplant recipients

• Published in: Clinical transplantation Vol. 20; no. 5; pp. 571 - 581
• Main Authors: Sandrini, Silvio, Maffeis, Roberto, Setti, Gisella, Bossini, Nicola, Maiorca, Paolo, Maffei, Camilla, Guerini, Simona, Zubani, Roberto, Portolani, Nazario, Bonardelli, Stefano, Nodari, Franco, Giulini, Stefano Maria, Cancarini, Giovanni
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01-09-2006; Blackwell
• Subjects: Adult; Atherosclerosis (general aspects, experimental research); Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; cardiovascular disease; cardiovascular risk-factors; Coronary Disease - mortality; Coronary Disease - prevention & control; Female; Follow-Up Studies; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Graft Rejection; Humans; Immunosuppression - methods; kidney transplantation; Kidney Transplantation - mortality; Male; Medical sciences; Middle Aged; Myocardial Infarction - mortality; Myocardial Infarction - prevention & control; Postoperative Complications - prevention & control; Retrospective Studies; steroid withdrawal; Steroids - adverse effects; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Tissue, organ and graft immunology; Cardiovascular disease; Homotransplantation; Epidemiology; Kidney; Vascular disease; Surgery; Treatment withdrawal; Atherosclerosis; Graft; steroid withdrawal; Human; Corticosteroid; Chronic disease; Mortality; Patient; Long term; cardiovascular risk-factors; Morbidity; Medicine; Immunosuppression; Treatment; Urinary system; Risk factor; Cardiovascular risk; Kidney transplantation
• ISSN: 0902-0063; 1399-0012
• DOI: 10.1111/j.1399-0012.2006.00579.x

:  The aim of this retrospective study was to assess the impact of steroid therapy on cardiovascular disease (CVD) and patient mortality, in 486 on‐CsA renal transplant recipients, with a follow‐up of 9.5 ± 4.3 yr. Two hundred and one patients had their steroids permanently withdrawn at sixth month after transplantation (G1); 285 patients did not (G2) as they were unable (acute rejection after suspension) or unsuitable (because of clinical criteria or immunosuppressive protocols). The CVD considered were coronary artery disease diagnosed by angiography and myocardial infarction. G1 and G2 patients were well‐matched regarding CVD risk factors, except for age (G1: 44 ± 14 yr; G2: 40 ± 12 yr; p < 0.003), incidence of male (G1: 62%; G2: 72%, p < 0.02) incidence of acute rejection (G1: 39%; G2: 83%, p < 0.0001). Both CVD and deaths occurring during the first year of transplantation were excluded from the analysis. At 20 yr, the cumulative probability of developing a CVD, was 3.8% in G1; 23.8% in G2 (p < 0.0005). Patient survival rate was 95% in G1; 62% in G2 (p < 0.003). Mortality caused by CVD was higher in G2 (4.2% vs. 0.5%; p < 0.03). The Cox analysis identified in steroid therapy the main independent risk factors for both CVD (hazard ratio 9.56 p < 0.0001) and patient mortality (hazard ratio 5.99, p < 0.0001). At 10th and 15th year after transplantation, the mean‐daily dose of steroids was 4.2 mg.
In the long‐term, steroid therapy, even in low‐doses, increases significantly both the rate of CVD and patient mortality. This retrospective study suggests that steroid‐free regime should always be recommended for the prevention of post‐transplant CVD. This relevant statement should be followed by a long‐term prospective study.