Early Steroid Withdrawal in Recipients of a Kidney Transplant From a Living Donor: Experience of a Single Mexican Center J. Andrade-Sierra a,b,c, *, E. Rojas-Campos a , E. Cardona-Muñoz c , L.A. Evangelista-Carrillo b , B. Gómez-Navarro b , E. González-Espinoza b , O. Lugo-Lopez b , J.I. Cerrillos-Gutiérrez b , M. Medina-Pérez b , B. Jalomo-Martínez b , J.J. Nieves-Hernández b , M. Sandoval b , J.R. Abundis-Jiménez b , J.N. Ramírez-Robles b , M.A. Villanueva-Pérez b , F. Monteón-Ramos b , and A.M. Cueto-Manzano a a Medical Research Unit in Renal Diseases, Guadalajara, Jalisco, Mexico; b Department of Nephrology and Organ Transplant Unit of the Specialties Hospital, Western National Medical Center, Mexican Social Security Institute (IMSS), Guadalajara, Jalisco, Mexico; and c Department of Physiology, Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Jalisco, Mexico ABSTRACT Background. Early steroid withdrawal (ESW) can improve lipid and hemodynamic profiles without severe acute rejection (AR) events in renal transplant patients. Our objective was to evaluate the effects of ESW on the frequency and severity of AR. Methods. A randomized, open-label, controlled clinical trial was performed on renal transplant recipients with a follow-up of 12 months. In the ESW group, patients were selected for corticosteroid treatment withdrawal on the fifth day post transplantation. In the Control group, patients continued with steroid treatment. All patients were over 18 years of age with panel reactive antibody (PRA) class I and II HLA <20%. Results. In total, 71 patients, 37 in the ESW group (52.1%) and 34 in the Control group (47.9%), had comparable AR incidences at the end of the follow-up (16% vs 15%) (NS) (RR ¼ 1.20, 95% CI ¼ 0.32e3.33). Although renal graft survival was similar between the ESW and Control groups (87% vs 94%), renal function was superior in the ESW group (85 vs 75 mL/min). Additionally, hypertension was less frequent in the ESW group (3% vs 35%), requiring the use of fewer antihypertensives (8% vs 50%). Conclusions. ESW was also associated with better blood pressure control and similar AR risk. The ESW group exhibited stable renal function. N OWADAYS, strategies are being developed to reduce or eliminate the use of steroids after transplantation, due to their harmful side effects and lack of benefit with regard to long-term graft and patient survival [1e7]. Some meta-analyses indicate that kidney graft rejection with nonsteroidal immunosuppression shows mild rejection characteristics with no negative impact on graft function or patient survival [8,9]. However, this type of intervention remains controversial [10e12]. Current clinical practice, following the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines, suggests that steroids can be with- drawn with low immunological risk from patients receiving induction immunosuppressive therapy after kidney trans- plantation (KT) [13]. In Mexico, there is limited informa- tion regarding early steroid withdrawal (ESW) after transplantation, which is not commonly practiced [14]. In our hospital, the largest percentage of KT cases consists of living donors with low immunological risk. In most cases, these patients are placed on a steroid-based immunosup- pressive regimen with mycophenolate mofetil (MMF) and a calcineurin inhibitor, either tacrolimus (TAC) or cyclo- sporine (CsA) [15]. We believe that steroid withdrawal after transplantation could be beneficial, due to the low *Address correspondence to Jorge Andrade-Sierra, PhD, Department of Physiology, Centro Universitario de Ciencias de la Salud, University of Guadalajara, Department of Nephrology and Organ Transplant Unit and Medical Research Unit in Renal Dis- eases of the Specialties Hospital, Western National Medical Center, Mexican Social Security Institute (IMSS), Belisario Dominguez N  1000, Col.Independencia, Guadalajara Jalisco, México CP 44320. E-mail: Jorg_Andrade@hotmail.com 0041-1345/16 http://dx.doi.org/10.1016/j.transproceed.2015.12.013 ª 2016 by Elsevier Inc. All rights reserved. 360 Park Avenue South, New York, NY 10010-1710 42 Transplantation Proceedings, 48, 42e49 (2016)