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oai:recercat.cat:2445/1777782025-12-05T12:30:08Zcom_2072_1057col_2072_478798col_2072_478916col_2072_478917

Clinical Relevance of Corticosteroid Withdrawal on Graft Histological Lesions in Low-Immunological-Risk Kidney Transplant Patients Hernández, Domingo Alonso Titos, Juana Vázquez, Teresa León, Myriam Caballero, Abelardo Cobo, María Angeles Sola, Eugenia López, Verónica Ruiz Esteban, Pedro Cruzado, Josep Ma. Sellarés, Joana Moreso, Francesc Manonelles, Anna Torío, Alberto Cabello, Mercedes Delgado Burgos, Juan Casas, Cristina Gutiérrez, Elena Jironda, Cristina Kanter, Julia Serón, Daniel Torres, Armando Trasplantament renal Biòpsia Corticosteroides Kidney transplantation Biopsy Adrenocortical hormones The impact of corticosteroid withdrawal on medium-term graft histological changes in kidney transplant (KT) recipients under standard immunosuppression is uncertain. As part of an open-label, multicenter, prospective, phase IV, 24-month clinical trial (ClinicalTrials.gov, NCT02284464) in low-immunological-risk KT recipients, 105 patients were randomized, after a protocol-biopsy at 3 months, to corticosteroid continuation (CSC, n = 52) or corticosteroid withdrawal (CSW, n = 53). Both groups received tacrolimus and MMF and had another protocol-biopsy at 24 months. The acute rejection rate, including subclinical inflammation (SCI), was comparable between groups (21.2 vs. 24.5%). No patients developed dnDSA. Inflammatory and chronicity scores increased from 3 to 24 months in patients with, at baseline, no inflammation (NI) or SCI, regardless of treatment. CSW patients with SCI at 3 months had a significantly increased chronicity score at 24 months. HbA1c levels were lower in CSW patients (6.4 +/- 1.2 vs. 5.7 +/- 0.6%; p = 0.013) at 24 months, as was systolic blood pressure (134.2 +/- 14.9 vs. 125.7 +/- 15.3 mmHg; p = 0.016). Allograft function was comparable between groups and no patients died or lost their graft. An increase in chronicity scores at 2-years post-transplantation was observed in low-immunological-risk KT recipients with initial NI or SCI, but CSW may accelerate chronicity changes, especially in patients with early SCI. This strategy did, however, improve the cardiovascular profiles of patients. 2021-05-28T09:29:37Z 2021-05-28T09:29:37Z 2021-05-07 2021-05-28T06:49:58Z info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion Reproducció del document publicat a: https://doi.org/10.3390/jcm10092005 Journal of Clinical Medicine, 2021, vol. 10, num. 9 https://doi.org/10.3390/jcm10092005 cc by (c) Hernández et al., 2021 http://creativecommons.org/licenses/by/3.0/es/ info:eu-repo/semantics/openAccess MDPI Articles publicats en revistes (Institut d'lnvestigació Biomèdica de Bellvitge (IDIBELL))