Lowering the Dose of Corticosteroid Regimen in Kidney Transplantation: Is It Effective in Decreasing Post-operative Surgical Complications?

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simforoosh Nasser; Nayebzade Amirhossein; Dadpour Mehdi; Eslami Atefe

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Journal Paper

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Journal: UROLOGY JOURNAL Year:2023 | Volume:20 | Issue:5 Page(s): 350-354

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Title

Lowering the Dose of Corticosteroid Regimen in Kidney Transplantation: Is It Effective in Decreasing Post-operative Surgical Complications?

Author(s)

simforoosh Nasser | Nayebzade Amirhossein | Dadpour Mehdi | Eslami Atefe | Issue Writer Certificate

Keywords

kidney transplantation

corticosteroid

administration and dosage

postoperative complications

survival analysis

Abstract

Purpose: To investigate the impact of reducing post-operative oral corticosteroid regimen on associated postoperative surgical complication rate, patient and graft survival in kidney transplant patients. Materials and Methods: In this retrospective cohort study, we enrolled patients who received a kidney transplant during two periods of distinct corticosteroid protocols. 592 patients in group 1 received prednisone 2 mg/kg (maximum dose 120 mg) on post-operative days (POD) 1, 2 and 3, 1mg/kg for a week, and tapered it to 10 mg by 3 months post-transplant and sustained the daily 10mg from 3 months post-transplant as maintenance therapy. 639 patients in group 2 received prednisone 50 mg on POD 1, 40mg on POD 2, 30mg on POD 3, 20mg on POD 4, 15mg on POD 5 and continued with 10mg daily from POD 6, as maintenance therapy. The two groups were similar in terms of other immunosuppression drug regimens. Results: 75 (12. 7%) patients in group 1 and 24 (3. 4%) patients in group 2 developed corticosteroid-related postoperative surgical complications (P <. 001). Wound infection (P =. 035), incisional hernia (P =. 003), infectious collection (P =. 004), post-op hemorrhage (P =. 005) and ureteral fistula (P =. 076) occurred with lower frequency in group 2. Patient survival (1-year: 97. 3% vs 97. 1%, respectively,P =. 85, 5-year: 89. 9% vs 94. 9%, respectively,P =. 06) and graft survival (1-year: 94. 6% vs 93. 3%, respectively,P =. 29, 5-year: 81. 2% vs 85. 1%, respectively,P =. 39) were similar in both groups. Conclusion: Post-operative corticosteroid dosage decrement through our protocol would lessen the serious associated postoperative surgical complications, without negative impacts on overall patient and graft survival

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