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Nefrología (Madrid)
versão On-line ISSN 1989-2284versão impressa ISSN 0211-6995
Resumo
MONFA, Elena et al. Intermediate steroid withdrawal after renal transplantation and anti-HLA antibodies (HLA-Abs) development. Nefrología (Madr.) [online]. 2017, vol.37, n.4, pp.415-422. ISSN 1989-2284. https://dx.doi.org/10.1016/j.nefro.2017.02.002.
Introduction:
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.
Palavras-chave : Kidney transplantation; Immunosuppression; Withdrawal; Steroids; Anti-HLA-antibodies.