{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T16:32:39Z","timestamp":1787502759867,"version":"build-2736575974"},"reference-count":36,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","funder":[{"DOI":"10.13039\/100001463","name":"American Society of Nephrology","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100001463","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"publisher","award":["K23DK115908"],"award-info":[{"award-number":["K23DK115908"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"publisher","award":["F32DK113719"],"award-info":[{"award-number":["F32DK113719"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"publisher","award":["R01DK120518"],"award-info":[{"award-number":["R01DK120518"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"publisher","award":["R01DK102981"],"award-info":[{"award-number":["R01DK102981"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"publisher","award":["K24DK101828"],"award-info":[{"award-number":["K24DK101828"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JASN"],"published-print":{"date-parts":[[2020,1]]},"abstract":"\n Significance Statement<\/jats:title>\n Early steroid withdrawal (ESW) is a maintenance immunosuppression strategy to avoid the sequelae of long-term steroid use in kidney transplant (KT) recipients. Recipients with delayed graft function (DGF) may have a suboptimal allograft milieu, which may alter the risk\/benefit equation of ESW. In this nationwide study, the authors found use of ESW in recipients with DGF varied at United States transplant centers. The authors also identified differences in outcomes after ESW in patients with and without DGF. Among recipients with immediate graft function, ESW was associated with possible harms such as increased rejection and benefits such as decreased mortality. However, among recipients with DGF, ESW was associated only with possible harms, including increased acute rejection and graft failure. Recipients with DGF also saw no change mortality with ESW. Our findings suggest ESW is harmful in KT recipients with DGF.<\/jats:p>\n <\/jats:sec>\n \n Background<\/jats:title>\n Early steroid withdrawal (ESW) is associated with acceptable outcomes in kidney transplant (KT) recipients. Recipients with delayed graft function (DGF), however, often have a suboptimal allograft milieu, which may alter the risk\/benefit equation for ESW. This may contribute to varying practices across transplant centers.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Using the Scientific Registry of Transplant Recipients, we studied 110,019 adult deceased-donor KT recipients between 2005 and 2017. We characterized the association of DGF with the use of ESW versus continued steroid maintenance across KT centers, and quantified the association of ESW with acute rejection, graft failure, and mortality using multivariable logistic and Cox regression with DGF-ESW interaction terms.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Overall 29.2% of KT recipients underwent ESW. Recipients with DGF had lower odds of ESW (aOR=\n 0.60<\/jats:sub>\n 0.67\n 0.75<\/jats:sub>\n ). The strength of this association varied across 261 KT centers, with center-specific aOR of <0.5 at 31 (11.9%) and >1.0 at 22 (8.4%) centers. ESW was associated with benefits and harms among recipients with immediate graft function (IGF), but only with harms among recipients with DGF. ESW was associated with increased acute rejection (aOR=\n 1.09<\/jats:sub>\n 1.16\n 1.23<\/jats:sub>\n ), slightly increased graft failure (aHR=\n 1.01<\/jats:sub>\n 1.06\n 1.12<\/jats:sub>\n ), but decreased mortality (aHR=\n 0.86<\/jats:sub>\n 0.89\n 0.93<\/jats:sub>\n ) among recipients with IGF. Among recipients with DGF, ESW was associated with a similar increase in rejection (aOR=1.12; 95% CI, 1.02 to 1.23), a more pronounced increase in graft failure (aHR=1.16; 95% CI, 1.08 to 1.26), and no improvement in mortality (aHR=1.00; 95% CI, 0.94 to 1.07). DGF-ESW interaction was statistically significant for graft failure (\n P<\/jats:italic>\n =0.04) and mortality (\n P<\/jats:italic>\n =0.003), but not for rejection (\n P<\/jats:italic>\n =0.6).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n KT centers in the United States use ESW inconsistently in recipients with DGF. Our findings suggest ESW may lead to worse KT outcomes in recipients with DGF.<\/jats:p>\n <\/jats:sec>","DOI":"10.1681\/asn.2019040416","type":"journal-article","created":{"date-parts":[[2019,12,18]],"date-time":"2019-12-18T16:45:12Z","timestamp":1576687512000},"page":"175-185","source":"Crossref","is-referenced-by-count":33,"title":["Early Steroid Withdrawal in Deceased-Donor Kidney Transplant Recipients with Delayed Graft Function"],"prefix":"10.1681","volume":"31","author":[{"given":"Sunjae","family":"Bae","sequence":"first","affiliation":[{"name":"Epidemiology and"},{"name":"Biostatistics, Johns Hopkins School of Public Health, Baltimore, Maryland;"},{"name":"Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacqueline M.","family":"Garonzik Wang","sequence":"additional","affiliation":[{"name":"Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allan B.","family":"Massie","sequence":"additional","affiliation":[{"name":"Epidemiology and"},{"name":"Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8135-5377","authenticated-orcid":false,"given":"Kyle R.","family":"Jackson","sequence":"additional","affiliation":[{"name":"Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3013-925X","authenticated-orcid":false,"given":"Mara A.","family":"McAdams-DeMarco","sequence":"additional","affiliation":[{"name":"Epidemiology and"},{"name":"Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel C.","family":"Brennan","sequence":"additional","affiliation":[{"name":"Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krista L.","family":"Lentine","sequence":"additional","affiliation":[{"name":"Center for Abdominal Transplantation, Saint Louis University, St. Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4598-0669","authenticated-orcid":false,"given":"Josef","family":"Coresh","sequence":"additional","affiliation":[{"name":"Epidemiology and"},{"name":"Biostatistics, Johns Hopkins School of Public Health, Baltimore, Maryland;"},{"name":"Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1924-4801","authenticated-orcid":false,"given":"Dorry L.","family":"Segev","sequence":"additional","affiliation":[{"name":"Epidemiology and"},{"name":"Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2019,12,18]]},"reference":[{"issue":"Suppl 1","key":"B1-20230819","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1111\/ajt.14557","article-title":"OPTN\/SRTR 2016 annual data report: Kidney.","volume":"18","author":"Hart","year":"2018","journal-title":"Am J Transplant"},{"key":"B2-20230819","doi-asserted-by":"crossref","first-page":"564","DOI":"10.1097\/SLA.0b013e318187d1da","article-title":"A prospective, randomized, double-blind, placebo-controlled multicenter trial comparing early (7 day) corticosteroid cessation versus long-term, low-dose corticosteroid therapy.","volume":"248","author":"Woodle","year":"2008","journal-title":"Ann Surg"},{"key":"B3-20230819","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1111\/j.1600-6143.2007.02057.x","article-title":"A randomized, multicenter study of steroid avoidance, early steroid withdrawal or standard steroid therapy in kidney transplant recipients.","volume":"8","author":"Vincenti","year":"2008","journal-title":"Am J Transplant"},{"key":"B4-20230819","doi-asserted-by":"crossref","first-page":"1734","DOI":"10.1097\/01.tp.0000188300.26762.74","article-title":"Two corticosteroid-free regimens-tacrolimus monotherapy after basiliximab administration and tacrolimus\/mycophenolate mofetil-in comparison with a standard triple regimen in renal transplantation: Results of the Atlas study.","volume":"80","author":"V\u00edtko","year":"2005","journal-title":"Transplantation"},{"key":"B5-20230819","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1016\/j.surg.2004.10.013","article-title":"Randomized prospective trial of early steroid withdrawal compared with low-dose steroids in renal transplant recipients using serial protocol biopsies to assess efficacy and safety.","volume":"137","author":"Laftavi","year":"2005","journal-title":"Surgery"},{"key":"B6-20230819","doi-asserted-by":"crossref","first-page":"707","DOI":"10.1093\/ndt\/gfm621","article-title":"A randomized exploratory trial of steroid avoidance in renal transplant patients treated with everolimus and low-dose cyclosporine.","volume":"23","author":"Montagnino","year":"2008","journal-title":"Nephrol Dial Transplant"},{"key":"B7-20230819","doi-asserted-by":"crossref","first-page":"807","DOI":"10.1097\/01.TP.0000154915.20524.0A","article-title":"Corticosteroid-free immunosuppression with tacrolimus, mycophenolate mofetil, and daclizumab induction in renal transplantation.","volume":"79","author":"Rostaing","year":"2005","journal-title":"Transplantation"},{"key":"B8-20230819","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1111\/j.1432-2277.2009.00971.x","article-title":"Corticosteroid avoidance in adult kidney transplant recipients under rabbit anti-T-lymphocyte globulin, mycophenolate mofetil and delayed cyclosporine microemulsion introduction.","volume":"23","author":"Cantarovich","year":"2010","journal-title":"Transpl Int"},{"key":"B9-20230819","doi-asserted-by":"crossref","first-page":"2473","DOI":"10.1111\/j.1600-6143.2005.01051.x","article-title":"Prednisone-free maintenance immunosuppression-a 5-year experience.","volume":"5","author":"Matas","year":"2005","journal-title":"Am J Transplant"},{"key":"B10-20230819","doi-asserted-by":"crossref","first-page":"494","DOI":"10.2215\/CJN.08630811","article-title":"Ten-year outcome after rapid discontinuation of prednisone in adult primary kidney transplantation.","volume":"7","author":"Rizzari","year":"2012","journal-title":"Clin J Am Soc Nephrol"},{"key":"B11-20230819","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/TP.0b013e3181c518cc","article-title":"Steroid avoidance or withdrawal after renal transplantation increases the risk of acute rejection but decreases cardiovascular risk. 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