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Kidney Week

Abstract: FR-PO1190

Surveillance Biopsy-Driven Steroid Withdrawal

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Weekers, Laurent E., CHU ULg, Esneux, Belgium
  • Pottel, Hans, KULeuven, Kortrijk, Belgium
  • Bonvoisin, Catherine, CHU ULg, Esneux, Belgium
  • Jouret, Francois, University of Liege Hospital (ULg CHU), Liege, Belgium
Background

Steroids withdrawal (SW) is the most frequently used IS minimizing-strategy, but it increases the risk of AR. We reasoned that surveillance biopsy (SB) could help individualized selection of patients with low risk of AR after SW. We implemented a systematic SB-driven SW protocol since 2007. We present a critical appraisal of the safety, efficiency and utility of this procedure.

Methods

Mono-centric analysis of all KTx performed from 2007 to 2015 and followed until March 2019. SB was performed at a prednisolone dose of 5 mg. SW was only allowed in kidney transplant (KT) with no sign of rejection (including borderline). Combining the two possible interventions (SB and SW) and adherence to the clinical protocol, we defined 6 groups as depicted in the study flow-chart.
The safety and efficiency analysis are purely descriptive. The primary end-point for the utility analysis is the prevalence of late (occurring after the intervention) AR and the secondary is time-to-event analysis (Cox model) of a combination of graft lost or eGFR decline>30% from 1 to 3 years post-KTx.

Results

The complication rate after SB was 2,5%: 1,8 % requiring non- or minimally-invasive intervention and 0,3% necessitating an embolization. No graft lost or procedure-related death was encountered.
Out of the 481 KTx analyzed, 169 (35%) were withdrawn from steroids after SB and 97 (20%) showed some degree of SCAR.
Rate of late AR were distributed as follow: [SW pp] 6%, [No SW vp] 8%, [No SW pp] 14% and [SW vp] 22% (Chi-2 for trend 0.008).
Breakdown of the population according to pre-specified groups was associated to the secondary end-point in both total (p=0.0002) and death-censored (p=0.019) in univariate analysis with [SW pp] being among the best survival groups.

Conclusion

SB-driven SW was safe and associated with good long term outcome.