UNOS/OPTN Data-guided Assessment of Focal Segmental Glomerulosclerosis After Kidney Transplantation and Evaluation of Immunosuppressive Protocols in a Steroid-free Center
Background. Focal segmental glomerulosclerosis (FSGS) is a common recurrent glomerulopathy associated with graft loss and patient survival after kidney transplantation (KT). However, its natural history, clinical predictors, and treatment response are still poorly understood. Steroid withdrawal regi...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer
2021-09-01
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| Series: | Transplantation Direct |
| Online Access: | http://journals.lww.com/transplantationdirect/fulltext/10.1097/TXD.0000000000001196 |
| _version_ | 1818718649598345216 |
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| author | Sunil M. Kurian, PhD Samantha R. Spierling Bagsic, PhD Jamie Case, PhD Bethany L. Barrick, BS Randolph Schaffer, MD James C. Rice, MD Christopher L. Marsh, MD |
| author_facet | Sunil M. Kurian, PhD Samantha R. Spierling Bagsic, PhD Jamie Case, PhD Bethany L. Barrick, BS Randolph Schaffer, MD James C. Rice, MD Christopher L. Marsh, MD |
| author_sort | Sunil M. Kurian, PhD |
| collection | DOAJ |
| description | Background. Focal segmental glomerulosclerosis (FSGS) is a common recurrent glomerulopathy associated with graft loss and patient survival after kidney transplantation (KT). However, its natural history, clinical predictors, and treatment response are still poorly understood. Steroid withdrawal regimens in KT have been associated with improvements in cardiovascular risk and patient outcomes. The Scripps Center for Organ Transplantation (SCOT) uses a rapid low-dose steroid withdrawal immunosuppression (IS) protocol for KT maintenance.
Methods. We assessed the impact of our protocol on FSGS disease recurrence over a 10-y period to reassess our steroid and IS protocols and to evaluate if our patient outcomes diverge from published data. We compared 4 groups: steroids always, steroid free, steroid switch on, and steroid weaned off. We used IS and induction-matched retrospective data from United Network for Organ Sharing (UNOS) to investigate patient and graft survival for FSGS at SCOT.
Results. Our analysis results differ from earlier studies showing that FSGS was associated with a higher risk of graft loss, perhaps because of selection of a UNOS data set filtered to match the SCOT IS protocol for making direct comparisons. Overall outcomes of graft failure and recipient death did not differ between SCOT patients and steroid-free transplant patient data from the UNOS data for FSGS. SCOT recurrence rate for FSGS was 7.5%, which was lower than in most published single-center studies.
Conclusions. Based on our results, we believe that it is safe to continue the steroid avoidance protocols at SCOT and the steroid-free protocol may not be detrimental when the adverse effects and toxicities associated with steroid use are considered. |
| first_indexed | 2024-12-17T19:54:24Z |
| format | Article |
| id | doaj.art-950f3e7a788f476d8e4e05649861ea02 |
| institution | Directory Open Access Journal |
| issn | 2373-8731 |
| language | English |
| last_indexed | 2024-12-17T19:54:24Z |
| publishDate | 2021-09-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | Transplantation Direct |
| spelling | doaj.art-950f3e7a788f476d8e4e05649861ea022022-12-21T21:34:38ZengWolters KluwerTransplantation Direct2373-87312021-09-0179e73810.1097/TXD.0000000000001196202109000-00001UNOS/OPTN Data-guided Assessment of Focal Segmental Glomerulosclerosis After Kidney Transplantation and Evaluation of Immunosuppressive Protocols in a Steroid-free CenterSunil M. Kurian, PhD0Samantha R. Spierling Bagsic, PhD1Jamie Case, PhD2Bethany L. Barrick, BS3Randolph Schaffer, MD4James C. Rice, MD5Christopher L. Marsh, MD61 Division of Organ Transplant, Scripps Center for Organ Transplantation, Scripps Clinic & Green Hospital, La Jolla, CA.3 Scripps Whittier Diabetes Institute, Scripps Health, San Diego, CA.1 Division of Organ Transplant, Scripps Center for Organ Transplantation, Scripps Clinic & Green Hospital, La Jolla, CA.1 Division of Organ Transplant, Scripps Center for Organ Transplantation, Scripps Clinic & Green Hospital, La Jolla, CA.1 Division of Organ Transplant, Scripps Center for Organ Transplantation, Scripps Clinic & Green Hospital, La Jolla, CA.1 Division of Organ Transplant, Scripps Center for Organ Transplantation, Scripps Clinic & Green Hospital, La Jolla, CA.1 Division of Organ Transplant, Scripps Center for Organ Transplantation, Scripps Clinic & Green Hospital, La Jolla, CA.Background. Focal segmental glomerulosclerosis (FSGS) is a common recurrent glomerulopathy associated with graft loss and patient survival after kidney transplantation (KT). However, its natural history, clinical predictors, and treatment response are still poorly understood. Steroid withdrawal regimens in KT have been associated with improvements in cardiovascular risk and patient outcomes. The Scripps Center for Organ Transplantation (SCOT) uses a rapid low-dose steroid withdrawal immunosuppression (IS) protocol for KT maintenance. Methods. We assessed the impact of our protocol on FSGS disease recurrence over a 10-y period to reassess our steroid and IS protocols and to evaluate if our patient outcomes diverge from published data. We compared 4 groups: steroids always, steroid free, steroid switch on, and steroid weaned off. We used IS and induction-matched retrospective data from United Network for Organ Sharing (UNOS) to investigate patient and graft survival for FSGS at SCOT. Results. Our analysis results differ from earlier studies showing that FSGS was associated with a higher risk of graft loss, perhaps because of selection of a UNOS data set filtered to match the SCOT IS protocol for making direct comparisons. Overall outcomes of graft failure and recipient death did not differ between SCOT patients and steroid-free transplant patient data from the UNOS data for FSGS. SCOT recurrence rate for FSGS was 7.5%, which was lower than in most published single-center studies. Conclusions. Based on our results, we believe that it is safe to continue the steroid avoidance protocols at SCOT and the steroid-free protocol may not be detrimental when the adverse effects and toxicities associated with steroid use are considered.http://journals.lww.com/transplantationdirect/fulltext/10.1097/TXD.0000000000001196 |
| spellingShingle | Sunil M. Kurian, PhD Samantha R. Spierling Bagsic, PhD Jamie Case, PhD Bethany L. Barrick, BS Randolph Schaffer, MD James C. Rice, MD Christopher L. Marsh, MD UNOS/OPTN Data-guided Assessment of Focal Segmental Glomerulosclerosis After Kidney Transplantation and Evaluation of Immunosuppressive Protocols in a Steroid-free Center Transplantation Direct |
| title | UNOS/OPTN Data-guided Assessment of Focal Segmental Glomerulosclerosis After Kidney Transplantation and Evaluation of Immunosuppressive Protocols in a Steroid-free Center |
| title_full | UNOS/OPTN Data-guided Assessment of Focal Segmental Glomerulosclerosis After Kidney Transplantation and Evaluation of Immunosuppressive Protocols in a Steroid-free Center |
| title_fullStr | UNOS/OPTN Data-guided Assessment of Focal Segmental Glomerulosclerosis After Kidney Transplantation and Evaluation of Immunosuppressive Protocols in a Steroid-free Center |
| title_full_unstemmed | UNOS/OPTN Data-guided Assessment of Focal Segmental Glomerulosclerosis After Kidney Transplantation and Evaluation of Immunosuppressive Protocols in a Steroid-free Center |
| title_short | UNOS/OPTN Data-guided Assessment of Focal Segmental Glomerulosclerosis After Kidney Transplantation and Evaluation of Immunosuppressive Protocols in a Steroid-free Center |
| title_sort | unos optn data guided assessment of focal segmental glomerulosclerosis after kidney transplantation and evaluation of immunosuppressive protocols in a steroid free center |
| url | http://journals.lww.com/transplantationdirect/fulltext/10.1097/TXD.0000000000001196 |
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