Late steroid withdrawal and cardiovascular events in kidney transplant recipients

Miha Arnol, Angelo M DeMattos, Jae S. Chung, Jonathan C. Prather, Anuja Mittalhenkle, Douglas J. Norman

Research output: Contribution to journalArticle

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Abstract

INTRODUCTION.: Cardiovascular events (CVE) are the leading cause of mortality in kidney transplant recipients. The adverse effects of long-term therapy with steroids on cardiovascular risk have motivated increasing interest in steroid withdrawal (SW). The objective of this study was to compare the incidences of CVE and all-cause mortality between patients who had undergone SW at 1 year posttransplant and control patients who continued on steroids. METHODS.: A cohort of 400 consecutive adult recipients of a kidney transplant between 1993 and 1998 who qualified for late SW was studied. At 1 year posttransplant 188 patients underwent SW, whereas 212 patients continued on steroids. Cox proportional-hazards analysis was used to estimate CVE (cardiac and cerebrovascular events) and all-cause mortality hazard ratios (HR) for patients who had undergone SW versus controls who continued on steroids beyond 1 year. RESULTS.: The average follow-up was 61 months. There were 44 (11%) cardiac events, 18 (4.5%) cerebrovascular events, and 41 deaths (10.3%). The composite outcome of CVE and all-cause mortality was reached in 26 (13.8%) subjects who had undergone SW and 50 (23.6%) controls (P=0.013). In adjusted analyses, SW was associated with decreased risk for the composite outcome (HR 0.46, 95% confidence interval [CI] 0.28-0.76), cardiac events (HR 0.48, 95% CI 0.28-0.84), and all-cause mortality (HR 0.27, 95% CI 0.12-0.59). There was no association of SW with the risk for cerebrovascular events (HR 1.76, 95% CI 0.45-7.01). CONCLUSION.: In this retrospective analysis, SW at 1 year posttransplant was associated with decreased risk for future CVE and all-cause mortality.

Original languageEnglish (US)
Pages (from-to)1844-1848
Number of pages5
JournalTransplantation
Volume86
Issue number12
DOIs
StatePublished - Dec 27 2008

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Steroids
Kidney
Mortality
Confidence Intervals
Transplant Recipients
Transplants
Incidence

Keywords

  • Cardiovascular events
  • Kidney transplantation
  • Patient mortality
  • Steroid withdrawal

ASJC Scopus subject areas

  • Transplantation

Cite this

Arnol, M., DeMattos, A. M., Chung, J. S., Prather, J. C., Mittalhenkle, A., & Norman, D. J. (2008). Late steroid withdrawal and cardiovascular events in kidney transplant recipients. Transplantation, 86(12), 1844-1848. https://doi.org/10.1097/TP.0b013e31818ffec0

Late steroid withdrawal and cardiovascular events in kidney transplant recipients. / Arnol, Miha; DeMattos, Angelo M; Chung, Jae S.; Prather, Jonathan C.; Mittalhenkle, Anuja; Norman, Douglas J.

In: Transplantation, Vol. 86, No. 12, 27.12.2008, p. 1844-1848.

Research output: Contribution to journalArticle

Arnol, M, DeMattos, AM, Chung, JS, Prather, JC, Mittalhenkle, A & Norman, DJ 2008, 'Late steroid withdrawal and cardiovascular events in kidney transplant recipients', Transplantation, vol. 86, no. 12, pp. 1844-1848. https://doi.org/10.1097/TP.0b013e31818ffec0
Arnol, Miha ; DeMattos, Angelo M ; Chung, Jae S. ; Prather, Jonathan C. ; Mittalhenkle, Anuja ; Norman, Douglas J. / Late steroid withdrawal and cardiovascular events in kidney transplant recipients. In: Transplantation. 2008 ; Vol. 86, No. 12. pp. 1844-1848.
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AU - Arnol, Miha

AU - DeMattos, Angelo M

AU - Chung, Jae S.

AU - Prather, Jonathan C.

AU - Mittalhenkle, Anuja

AU - Norman, Douglas J.

PY - 2008/12/27

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N2 - INTRODUCTION.: Cardiovascular events (CVE) are the leading cause of mortality in kidney transplant recipients. The adverse effects of long-term therapy with steroids on cardiovascular risk have motivated increasing interest in steroid withdrawal (SW). The objective of this study was to compare the incidences of CVE and all-cause mortality between patients who had undergone SW at 1 year posttransplant and control patients who continued on steroids. METHODS.: A cohort of 400 consecutive adult recipients of a kidney transplant between 1993 and 1998 who qualified for late SW was studied. At 1 year posttransplant 188 patients underwent SW, whereas 212 patients continued on steroids. Cox proportional-hazards analysis was used to estimate CVE (cardiac and cerebrovascular events) and all-cause mortality hazard ratios (HR) for patients who had undergone SW versus controls who continued on steroids beyond 1 year. RESULTS.: The average follow-up was 61 months. There were 44 (11%) cardiac events, 18 (4.5%) cerebrovascular events, and 41 deaths (10.3%). The composite outcome of CVE and all-cause mortality was reached in 26 (13.8%) subjects who had undergone SW and 50 (23.6%) controls (P=0.013). In adjusted analyses, SW was associated with decreased risk for the composite outcome (HR 0.46, 95% confidence interval [CI] 0.28-0.76), cardiac events (HR 0.48, 95% CI 0.28-0.84), and all-cause mortality (HR 0.27, 95% CI 0.12-0.59). There was no association of SW with the risk for cerebrovascular events (HR 1.76, 95% CI 0.45-7.01). CONCLUSION.: In this retrospective analysis, SW at 1 year posttransplant was associated with decreased risk for future CVE and all-cause mortality.

AB - INTRODUCTION.: Cardiovascular events (CVE) are the leading cause of mortality in kidney transplant recipients. The adverse effects of long-term therapy with steroids on cardiovascular risk have motivated increasing interest in steroid withdrawal (SW). The objective of this study was to compare the incidences of CVE and all-cause mortality between patients who had undergone SW at 1 year posttransplant and control patients who continued on steroids. METHODS.: A cohort of 400 consecutive adult recipients of a kidney transplant between 1993 and 1998 who qualified for late SW was studied. At 1 year posttransplant 188 patients underwent SW, whereas 212 patients continued on steroids. Cox proportional-hazards analysis was used to estimate CVE (cardiac and cerebrovascular events) and all-cause mortality hazard ratios (HR) for patients who had undergone SW versus controls who continued on steroids beyond 1 year. RESULTS.: The average follow-up was 61 months. There were 44 (11%) cardiac events, 18 (4.5%) cerebrovascular events, and 41 deaths (10.3%). The composite outcome of CVE and all-cause mortality was reached in 26 (13.8%) subjects who had undergone SW and 50 (23.6%) controls (P=0.013). In adjusted analyses, SW was associated with decreased risk for the composite outcome (HR 0.46, 95% confidence interval [CI] 0.28-0.76), cardiac events (HR 0.48, 95% CI 0.28-0.84), and all-cause mortality (HR 0.27, 95% CI 0.12-0.59). There was no association of SW with the risk for cerebrovascular events (HR 1.76, 95% CI 0.45-7.01). CONCLUSION.: In this retrospective analysis, SW at 1 year posttransplant was associated with decreased risk for future CVE and all-cause mortality.

KW - Cardiovascular events

KW - Kidney transplantation

KW - Patient mortality

KW - Steroid withdrawal

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