Without immunosuppressants
According to the results of a study conducted by transplantologists from the University of Cincinnati and the University of California, the long-term appointment of hormone therapy for the treatment of patients after kidney transplantation is not always appropriate.
A randomized clinical trial involving 385 patients assessed whether immunosuppressive drugs could be given up seven days after kidney transplantation. All patients in the study took tacrolimus and mycophenolate – non-hormonal immunosuppressants, they were randomized into groups of long-term corticosteroid prescribing or withdrawal from the second week after surgery. The study showed that 15 years after transplantation, there were no differences in the survival rate of a kidney transplant or the survival rate of patients in the group that received corticosteroids for a long time and the group in which corticosteroids were canceled.
Corticosteroids with prolonged use cause a number of unpleasant side effects. According to the authors' observations, after kidney transplantation, patients most often complain of various side effects of corticosteroids, including unpleasant changes in appearance and abnormal fat distribution.
In addition to cosmetic effects, corticosteroids cause bone disease and lead to the loss of collagen in the tissues, which leads to bruises and stretch marks on the skin. Steroid diabetes, high blood pressure and high cholesterol increase the risk of cardiovascular complications, which in the long term reduces the survival of patients.
A prospective randomized double-blind study was conducted on the basis of 28 kidney transplant centers. Five years after the start of the study, there were no differences in the rates of mortality associated with transplantation or other causes in the two groups. The frequency of symptoms of moderate and severe organ rejection also did not differ. There was a higher frequency of biopsy-confirmed (samples were taken from a transplanted kidney) signs of rejection in patients who stopped taking corticosteroids compared to those who continued taking them. Biopsy-confirmed signs were 7% more common in patients not taking corticosteroids, but doctors were able to reverse this effect with short-term use of corticosteroids.
Kidney function was similar between the groups who took and did not take corticosteroids, and parameters such as weight gain, serum triglycerides and the incidence of insulin-dependent diabetes were lower in patients who did not take corticosteroids.
The observation of patients in the study lasted more than 15 years, using information from the National Database of Transplants (United Network for Organ Sharing, UNOS). The result of the study in the United States may affect the treatment of more than 22,000 people who received a kidney transplant in 2020. Another 97,000 patients are on the waiting list for kidney transplantation.
Article by E.S.Woodle et al. Early Corticosteroid Cessation vs Long-term Corticosteroid Therapy in Kidney Transplant Recipients is published in JAMA Surgery.
Aminat Adzhieva, portal "Eternal Youth" http://vechnayamolodost.ru according to the University of Cincinnati: Transplant patients may not need steroid treatment in the long run.