신장이식 환자를 대상으로 시도한 스테로이드 중단 면역억제요법의 장기적인 효과

Abstract

Purpose: Early experience of steroid-free immunosuppressive protocol for kidney transplant recipient was unsatisfactory due to a remarkable incidence of acute rejection. We also attempted steroid-free protocol in 1990, and experienced painful early result. Therefore, steroid-free protocol have not been tried since 1990. Now, we retrospectively reviewed our experience of steroid-free protocol which was performed in 1990, and verified the long-term effect of steroid-free protocol. Methods: Among 149 recipients who underwent living donor kidney transplantation in 1990, 48 recipients with stable graft function were enrolled in this study. Cyclosporine and steroid were administrated as a maintenance immunosuppressive regimen without induction immunosuppression such as anti-lymphocyte antibodies. Steroid was gradually reduced for 6~8 weeks at 2~3 month after transplantation. If acute rejection or graft dysfunction was developed during tapering period or after cessation, steroid was restarted. And such tapering failure and restart group were defined as steroid-free failure group. We compared the clinical outcomes of steroid-free trial group compared with non-trial (control) group. Results: 17 (35.4%) of 48 recipients failed in steroid-free protocol finally. Acute rejection was the most common cause of steroid-free failure by 11 (64.7%) recipients, and most failure (12 recipients, 70.6%) occurred within 1 year after transplantation. Therefore failure group showed significant inferior graft survival rate than steroid-free group (35.3% versus 80.7%, P=0.001). The overall steroid-free trial group showed similar graft survival rate compared with control group. But the steroid-free group showed superior graft survival rate than control without statistical significance (80.7% versus 60.4%, P=0.383). And also showed lower incidence of post-transplant diabetes, hypertension, hyperlipidemia and bone disease without or with significance. Conclusion: The steroid-free protocol without addition of other immunosuppressive agent causes high incidence of acute rejection and poor graft survival. Hwoever, success group to steroid-free protocol shows beneficial effect in graft survival rate and post-transplant complications.