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

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20 Scopus citations

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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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