Early Steroid Withdrawal Cuts CV Event Rates in Transplant Recipients
Nicole Schmidt, PharmD
PHILADELPHIA—Kidney transplant patients who undergo early corticosteroid withdrawal (ECSWD) have a significantly better survival free of cardiovascular (CV) events, according to investigators. The decrease in CV event does not become apparent until three or four years after transplantation.
Although ECSWD reduces cardiovascular risk, long-term studies translating CV risk reduction into CV events and, ultimately, patient survival, have not been conducted, said investigator Nicole Schmidt, PharmD, of the University of Cincinnati in Ohio.
She and her colleagues analyzed prospective CV event data from 1,004 renal transplant recipients, of whom 714 received ECSWD (with corticosteroids withdrawn within seven days after transplantation) and 290 received chronic corticosteroid (CCS) maintenance regimens from 1998-2010. CV events included sudden death/CV-related death, myocardial infarction, angina/unstable angina, cerebrovascular accident/transient ischemic attack, or performance of a CV procedure.
The median follow-up period was 1,527 days for the ECSWD group versus 2,147 days for the CCS group.
At one year, the CCS group had a mean corticosteroid dose of 6.9 mg/day; at four years, it wsa 5.0 mg/day. A total of 267 CVEs occurred in 171 patients. Significantly fewer CV events occurred in the ECSWD group than in the CCS group (14% vs. 24.5%), Dr. Schmidt told attendees. According to Kaplan-Meier estimates, the 10-year CV event rates were 24% in the ECSWD group versus 35% in the CCS group. The decrease in CV events did not become apparent until three or four years post-transplant, Dr. Schmidt said. The two groups did not differ in CV-related mortality and overall mortality.
ECSWD patients had higher death-censored graft survival than the CCS patients, but not significantly so.
The ECSWD group had more coronary artery disease than the CCS group prior to transplantation (15.7% vs. 11.4%), but the difference was not significant. The CCS group had significantly more African American patients than the ECSWD group (27.9% vs. 20.4%) and significantly more women (45.9% vs. 38.1%).