Published online Sep 24, 2015. doi: 10.5500/wjt.v5.i3.102
Peer-review started: February 26, 2015
First decision: June 3, 2015
Revised: June 11, 2015
Accepted: August 13, 2015
Article in press: August 14, 2015
Published online: September 24, 2015
Core tip: This study critically evaluated the role of steroid maintenance in kidney transplant recipients (KTR) based on the level of sensitization by utilizing the Organ Procurement and Transplant Network/United Network of Organ Sharing database. In the multivariate model, we found an association between increased risk for death with functioning graft and steroid maintenance in KTRs who had peak-panel reactive antibody < 30% and received perioperative induction therapy followed by calcineurin inhibitor/mycophenolate mofetil maintenance. On the other hand, steroid maintenance was associated with improved death-censored graft survival without adversely impacting patient survival in KTRs with a peak PRA > 60%. No benefits of steroid maintenance were observed in older KTRs regardless of level of sensitization. These finding have clinical relevance and should be further evaluated in randomized clinical trials.