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oai:repisalud.isciii.es:20.500.12105/183342024-11-28T14:53:57Zcom_20.500.12105_15322com_20.500.12105_2051col_20.500.12105_16927col_20.500.12105_16962

00925njm 22002777a 4500 dc Hernández, Domingo author Alonso-Titos, Juana author Vázquez, Teresa author León, Myriam author Caballero, Abelardo author Cobo, María Angeles author Sola, Eugenia author López, Verónica author Ruiz-Esteban, Pedro author Cruzado, Josep María author Sellarés, Joana author Moreso, Francesc author Manonelles, Anna author Torío, Alberto author Cabello, Mercedes author Delgado-Burgos, Juan author Casas, Cristina author Gutiérrez, Elena author Jironda, Cristina author Kanter, Julia author Serón, Daniel author Torres, Armando author 2021-05-07 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. 10.3390/jcm10092005 2077-0383 Journal of Clinical Medicine http://hdl.handle.net/10668/4055 34067039 http://hdl.handle.net/20.500.12105/18334 Subclinical inflammation Kidney transplant Protocol biopsy Corticosteroids withdrawal Low immunological risk Rejection Borderline lesions Chronic graft histological changes Rechazo Corticoesteroides Trasplante de riñón Blood pressure Presión sanguínea Terapia de inmunosupresión Inflamación Clinical Relevance of Corticosteroid Withdrawal on Graft Histological Lesions in Low-Immunological-Risk Kidney Transplant Patients