Impact of early steroid withdrawal on progression of interstitial fibrosis and tubular atrophy after kidney transplantation

Introduction : Long-term effects of early steroid withdrawal (ESW) on development of chronic histopathology changes in kidney allograft are unclear. Methods : We compared chronic pathohistology scores on protocol biopsies in kidney recipients (N = 124) without delayed graft function with ESW (79) vs. continuous steroids (45) on top of calcineurin inhibitor and mycophenolate mofetil. Induction immunosuppression consisted of interleukin 2 receptor antibodies (IL-2R). Protocol biopsies were done at implantation and 1-year after transplantation. Chronic scores (ci, ct, cg, mm, cv and ah) were analyzed by the Banff 97 classification and it updates. Results : 1-year progression of interstitial fibrosis was similar in ESW versus continuous steroids group (0.52 ± 0.62 vs. 0.69 ± 0.76, p = 0.28). Similarly, progression of tubular atrophy was not different in ESW versus continuous steroids group (0.58 ± 0.67 vs. 0.76 ± 0.71, p = 0.17). There was not statistically different progression in any histopathology score between groups of immunosuppression on steroids or ESW. Kidney function was also similar at 3, 6 and 12 months between the ESW and steroid group. Conclusion : In conclusion, ESW does not have negative impact on progression of interstitial fibrosis and tubular atrophy. Kidney function was comparable between ESW and continuous steroids group on 3, 6 and 12 months after kidney transplantation.